Provider Demographics
NPI:1477337210
Name:DANIELS, ALEXA (NP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:DANIELS
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 1:711 E 5TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-8876
Mailing Address - Country:US
Mailing Address - Phone:781-738-8784
Mailing Address - Fax:
Practice Address - Street 1:81 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4505
Practice Address - Country:US
Practice Address - Phone:781-437-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2302491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner