Provider Demographics
NPI:1073121505
Name:KOOLMEES, ALEXANDRA R (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:R
Last Name:KOOLMEES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E VILLAGE CIRCLE DR S
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4818
Mailing Address - Country:US
Mailing Address - Phone:562-716-7677
Mailing Address - Fax:
Practice Address - Street 1:1141 E VILLAGE CIRCLE DR S
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4818
Practice Address - Country:US
Practice Address - Phone:562-716-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical