Provider Demographics
NPI:1508574377
Name:MCGINN, ALIX DIANA
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:DIANA
Last Name:MCGINN
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 1:10184 MCKENNA RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48845-9509
Mailing Address - Country:US
Mailing Address - Phone:517-914-0700
Mailing Address - Fax:
Practice Address - Street 1:10184 MCKENNA RD
Practice Address - Street 2:
Practice Address - City:HUBBARDSTON
Practice Address - State:MI
Practice Address - Zip Code:48845-9509
Practice Address - Country:US
Practice Address - Phone:517-914-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703126124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI164W00000XOtherSTATE OF MICHIGAN