Provider Demographics
NPI:1497954341
Name:ALEXOVICH, LOUANN PANCOAST (MIDWIFE)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:PANCOAST
Last Name:ALEXOVICH
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1711
Mailing Address - Country:US
Mailing Address - Phone:330-535-2671
Mailing Address - Fax:330-535-2987
Practice Address - Street 1:444 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1711
Practice Address - Country:US
Practice Address - Phone:330-535-2671
Practice Address - Fax:330-535-2987
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118045367A00000X
OH14007NM367A00000X
OHRN 211565163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078744Medicaid
OHH249320Medicare PIN