Provider Demographics
NPI:1477193167
Name:SEVERIN, ALEXIS MARIE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:SEVERIN
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 1:12 WEBSTER CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2834
Mailing Address - Country:US
Mailing Address - Phone:413-682-4451
Mailing Address - Fax:
Practice Address - Street 1:17 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2788
Practice Address - Country:US
Practice Address - Phone:413-549-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program