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General NPI Number Information
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NPI Number | 1013647551
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Entity Type | Individual
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Provider Name | ALEXA RAE WATTS PA
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Gender | Female
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 3170 CHILI AVE STE T1A
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City | ROCHESTER
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State | NY
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Zip | 14624-5452
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Country | US
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Telephone | 585-571-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 7519 ANTOINETTE CT
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City | SCHENECTADY
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State | NY
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Zip | 12303-5253
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Country | US
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Telephone | 518-253-9058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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