Provider Demographics
NPI:1518727833
Name:ALIX, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ALIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7691 E SAVANNA RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7634
Mailing Address - Country:US
Mailing Address - Phone:619-962-4111
Mailing Address - Fax:
Practice Address - Street 1:3100 E FLORENCE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7989
Practice Address - Country:US
Practice Address - Phone:619-962-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty