Provider Demographics
NPI:1164915328
Name:STALEOS, ALEXA DANIELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:DANIELLE
Last Name:STALEOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N17W26851 E FIELDHACK DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5486
Mailing Address - Country:US
Mailing Address - Phone:262-719-3247
Mailing Address - Fax:
Practice Address - Street 1:N17W26851 E FIELDHACK DR UNIT H
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5486
Practice Address - Country:US
Practice Address - Phone:262-719-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174087163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse