Provider Demographics
NPI:1033725122
Name:ALEXANDER, TANISHA LEE
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:LEE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANASHA
Other - Middle Name:LEE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:761 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1240
Mailing Address - Country:US
Mailing Address - Phone:316-312-1724
Mailing Address - Fax:316-453-6393
Practice Address - Street 1:761 N WEST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1240
Practice Address - Country:US
Practice Address - Phone:316-312-1724
Practice Address - Fax:316-453-6393
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist