Healthcare Provider Details

I. General information

NPI: 1922627991
Provider Name (Legal Business Name): ALEXANDRA MCCLENAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

IV. Provider business mailing address

PO BOX 3011
GILLETTE WY
82717-3011
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-3636
  • Fax: 307-688-7920
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number17257A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17257A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: