Provider Demographics
NPI:1164667549
Name:CHETTIAR, ALEXIS R (NP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:R
Last Name:CHETTIAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:B
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2905 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2017
Mailing Address - Country:US
Mailing Address - Phone:510-841-4525
Mailing Address - Fax:510-204-9086
Practice Address - Street 1:2905 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2017
Practice Address - Country:US
Practice Address - Phone:510-841-4525
Practice Address - Fax:510-204-9086
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 18561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner