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General NPI Number Information
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NPI Number | 1801642087
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Entity Type | Individual
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Provider Name | ALEXYIS FREDERICK CPT, CCMA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2024
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 3831 HOHMAN AVE # 1072
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City | HAMMOND
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State | IN
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Zip | 46327-1160
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Country | US
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Telephone | 872-256-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 3831 HOHMAN AVE # 1072
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City | HAMMOND
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State | IN
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Zip | 46327-1160
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Country | US
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Telephone | 872-256-0655
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3877-6669
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 3811-6669
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License Number State | AL
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