Provider Demographics
NPI:1194836981
Name:PODCZERVINSKI, ALEXANDRIA MARY (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:MARY
Last Name:PODCZERVINSKI
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:PO BOX 6514
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-6514
Mailing Address - Country:US
Mailing Address - Phone:989-340-1211
Mailing Address - Fax:989-340-1214
Practice Address - Street 1:1501 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-340-1211
Practice Address - Fax:989-340-1214
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant