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General NPI Number Information
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NPI Number | 1578193967
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Entity Type | Individual
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Provider Name | ALEXANDRA KRISTINE SHIVERS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 250 DEBARTOLO PL
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-7004
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Country | US
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Telephone | 330-729-8380
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Fax | 330-729-8399
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Provider Business Mailing Address
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Address Line | 697 E 15TH ST
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City | SALEM
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State | OH
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Zip | 44460-1251
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Country | US
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Telephone | 234-564-7586
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 207PH0002X
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License Number State | OH
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