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General NPI Number Information
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NPI Number | 1982975454
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Entity Type | Individual
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Provider Name | ALEXIS BROOKE MINCER PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/15/2012
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 9908 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19115
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Country | US
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Telephone | 215-464-2902
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Fax | 215-464-2954
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Provider Business Mailing Address
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Address Line | 1390 REVELATION RD
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City | JENKINTOWN
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State | PA
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Zip | 19046-1022
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Country | US
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Telephone | 610-203-3387
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA056041
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | OA006847
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License Number State | PA
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