MEDICARE: ALEXIS DAHL

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	9536461	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114627114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS DAHL

Provider Business Mailing Address
First Line	:	108 N 33RD CT
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6912
Country	:	US
Telephone Number	:	305-899-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 N 33RD CT
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6912
Country	:	US
Telephone Number	:	305-899-3230
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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Directions to “ ALEXIS DAHL ” Practice Location

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