Provider Demographics
NPI:1104210491
Name:AXTMAYER, ALFREDO II (APRN)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:AXTMAYER
Suffix:II
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK STREET
Mailing Address - Street 2:SMILOW CANCER CENTER - NP 8
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-200-4422
Mailing Address - Fax:203-200-6950
Practice Address - Street 1:20 YORK STREET
Practice Address - Street 2:SMILOW CANCER CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-200-4422
Practice Address - Fax:203-200-6950
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6923363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health