MEDICARE: ALEXANDRA JANOTA GAINES AGACNP-BC

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	363L00000X	Nurse Practitioner	17337-33	WI

General Provider Information

NPI Number	:	1245123728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA JANOTA GAINES AGACNP-BC

Provider Business Mailing Address
First Line	:	135 S GIBSON ST
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1622
Country	:	US
Telephone Number	:	715-748-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 S GIBSON ST
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1622
Country	:	US
Telephone Number	:	715-748-8100
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/22/2026

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