Provider Demographics
NPI:1528563384
Name:WILSON, ALEXANDRA GRACE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:GRACE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LEXI
Other - Middle Name:GRACE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1960 N OGDEN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3670
Practice Address - Country:US
Practice Address - Phone:303-318-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program