Healthcare Provider Details

I. General information

NPI: 1124689104
Provider Name (Legal Business Name): SYDNEY R ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PINE RIDGE BLVD
WAUSAU WI
54401
US

IV. Provider business mailing address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 283-800-2881
  • Fax:
Mailing address:
  • Phone: 701-857-8500
  • Fax: 701-857-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: