Provider Demographics
NPI:1265508535
Name:ALEXANDER ANDERSON, AVA
Entity Type:Individual
Prefix:MS
First Name:AVA
Middle Name:
Last Name:ALEXANDER ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6915 S 37TH GLEN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6175
Mailing Address - Country:US
Mailing Address - Phone:602-276-1112
Mailing Address - Fax:
Practice Address - Street 1:6915 S 37TH GLEN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6175
Practice Address - Country:US
Practice Address - Phone:602-276-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3796385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ869604OtherAHCCCS ID NUMBER