Provider Demographics
NPI:1093186603
Name:PRESLER, ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:
Last Name:PRESLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-3108
Mailing Address - Country:US
Mailing Address - Phone:602-677-6399
Mailing Address - Fax:
Practice Address - Street 1:21410 N 19TH AVE
Practice Address - Street 2:STE. 151
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2738
Practice Address - Country:US
Practice Address - Phone:602-677-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant