Provider Demographics
NPI:1376104976
Name:BAUTOCHKA, ALEXIS ANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANNE
Last Name:BAUTOCHKA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14090 HG TRUEMAN RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-3151
Mailing Address - Country:US
Mailing Address - Phone:518-527-9338
Mailing Address - Fax:
Practice Address - Street 1:41746 NEW MARKET TURNER RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-4831
Practice Address - Country:US
Practice Address - Phone:518-527-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily