Provider Demographics
NPI:1497396865
Name:WEDE, ALEXANDRA ERIN
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ERIN
Last Name:WEDE
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 1:819 30TH AVE S STE 208
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5054
Mailing Address - Country:US
Mailing Address - Phone:218-451-1004
Mailing Address - Fax:
Practice Address - Street 1:819 30TH AVE S STE 208
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5054
Practice Address - Country:US
Practice Address - Phone:701-426-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program