MEDICARE: ALEXIS ALTHENS LMT

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	173000000X	Legal Medicine	104606	AK

General Provider Information

NPI Number	:	1982068169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS ALTHENS LMT

Provider Business Mailing Address
First Line	:	34746 W GAMWAY DR
Second Line	:
City	:	SUTTON
State	:	AK
Zip	:	99674-8233
Country	:	US
Telephone Number	:	907-982-2372
Fax Number	:

Provider Business Practice Location Address
First Line	:	34746 W GAMWAY DR
Second Line	:
City	:	SUTTON
State	:	AK
Zip	:	99674-8233
Country	:	US
Telephone Number	:	907-982-2372
Fax Number	:

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

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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