MEDICARE: DEMETRA ALEXANDER

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	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1417593039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRA ALEXANDER

Provider Business Mailing Address
First Line	:	3845 QUEEN CREST AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3845 QUEEN CREST AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3926
Country	:	US
Telephone Number	:	513-814-3932
Fax Number	:

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

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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Directions to “ DEMETRA ALEXANDER ” Practice Location

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