Healthcare Provider Details

I. General information

NPI: 1245123728
Provider Name (Legal Business Name): ALEXANDRA JANOTA GAINES AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA JANOTA

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S GIBSON ST
MEDFORD WI
54451-1622
US

IV. Provider business mailing address

135 S GIBSON ST
MEDFORD WI
54451-1622
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-8100
  • Fax:
Mailing address:
  • Phone: 715-748-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17337-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: