MEDICARE: MARIA ALEXIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	400734	OH

General Provider Information

NPI Number	:	1033519905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ALEXIS

Provider Business Mailing Address
First Line	:	2750 WALLCREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4885
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 WALLCREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4885
Country	:	US
Telephone Number	:	216-466-4868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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