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General NPI Number Information
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NPI Number | 1851050199
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Entity Type | Individual
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Provider Name | ALEXA TRAKALO PA
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Gender | Female
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 2330 SIOUX TRL NW
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City | PRIOR LAKE
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State | MN
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Zip | 55372-9077
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Country | US
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Telephone | 952-496-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 SIOUX TRL NW
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City | PRIOR LAKE
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State | MN
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Zip | 55372-9077
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Country | US
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13895
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License Number State | MN
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