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General NPI Number Information
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NPI Number | 1841924990
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Entity Type | Individual
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Provider Name | ALEXANDRA ANNA BARTLOW
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Gender | Female
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 6051 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8969
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Country | US
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Telephone | 208-302-5150
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Fax | 208-302-5155
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-302-9342
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA-2710
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License Number State | ID
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