Provider Demographics
NPI:1417324419
Name:WILLARD, ALEXANDRA F (NP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:F
Last Name:WILLARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 W WHISPERING WIND DR STE 264
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2869
Mailing Address - Country:US
Mailing Address - Phone:623-235-6889
Mailing Address - Fax:602-339-0952
Practice Address - Street 1:6142 E BROWN RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4962
Practice Address - Country:US
Practice Address - Phone:602-339-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60291606163W00000X
AZ223861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse