Provider Demographics
NPI:1578135067
Name:METZGER, ALEXANDRA ELISABETH
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELISABETH
Last Name:METZGER
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 1:6064 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5350
Mailing Address - Country:US
Mailing Address - Phone:702-940-8007
Mailing Address - Fax:702-832-1940
Practice Address - Street 1:6064 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5350
Practice Address - Country:US
Practice Address - Phone:702-940-8007
Practice Address - Fax:702-832-1940
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVPA2537363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578135067Medicaid