Provider Demographics
NPI:1417232752
Name:JUZENAS, ALEXA LIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:LIANE
Last Name:JUZENAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:LIANE
Other - Last Name:KUNDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2809 N PARK DRIVE LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1603
Mailing Address - Country:US
Mailing Address - Phone:920-380-4999
Mailing Address - Fax:920-380-4989
Practice Address - Street 1:2809 N PARK DRIVE LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1603
Practice Address - Country:US
Practice Address - Phone:920-380-4999
Practice Address - Fax:920-380-4989
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11520363A00000X
WI2867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant