Provider Demographics
NPI:1386040731
Name:LEGUIRE, ALEXANDRA MARIE (MMS PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:LEGUIRE
Suffix:
Gender:F
Credentials:MMS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 N 7TH ST
Mailing Address - Street 2:APT 2178
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1128
Mailing Address - Country:US
Mailing Address - Phone:419-722-9045
Mailing Address - Fax:
Practice Address - Street 1:11001 N 7TH ST
Practice Address - Street 2:APT 2178
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1128
Practice Address - Country:US
Practice Address - Phone:419-722-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant