Provider Demographics
NPI:1477292928
Name:CAMERON, ALEXANDRA ALOHA (CN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ALOHA
Last Name:CAMERON
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 3RD ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3702
Mailing Address - Country:US
Mailing Address - Phone:253-881-1490
Mailing Address - Fax:253-881-1490
Practice Address - Street 1:1408 3RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3702
Practice Address - Country:US
Practice Address - Phone:253-881-1490
Practice Address - Fax:253-881-1490
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60936074133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist