Provider Demographics
NPI:1164975785
Name:CANTRELL, ALEXANDRIA LEE
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LEE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:LEE
Other - Last Name:STEGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 BIRCH CREST DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-1043
Mailing Address - Country:US
Mailing Address - Phone:810-348-8811
Mailing Address - Fax:
Practice Address - Street 1:12 BIRCH CREST DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-1043
Practice Address - Country:US
Practice Address - Phone:810-348-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other