Provider Demographics
NPI:1366835670
Name:SMITH-ELLISON, ALEXA CHRISTINE (RN, CNM, WHNP)
Entity Type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:CHRISTINE
Last Name:SMITH-ELLISON
Suffix:
Gender:F
Credentials:RN, CNM, WHNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2400 NE NEFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6752
Mailing Address - Country:US
Mailing Address - Phone:541-389-3300
Mailing Address - Fax:541-389-8115
Practice Address - Street 1:2400 NE NEFF RD STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6752
Practice Address - Country:US
Practice Address - Phone:541-389-3300
Practice Address - Fax:541-389-8115
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95002125363LW0102X
CA235726367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health