Provider Demographics
NPI:1417105875
Name:MILES, ALEXANDRIA SARA
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:SARA
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126A E COUNTRY FAIR DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6663
Mailing Address - Country:US
Mailing Address - Phone:907-841-6494
Mailing Address - Fax:907-864-0330
Practice Address - Street 1:4126A E COUNTRY FAIR DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6663
Practice Address - Country:US
Practice Address - Phone:907-841-6494
Practice Address - Fax:907-864-0330
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management