Provider Demographics
NPI:1578193967
Name:SHIVERS, ALEXANDRA KRISTINE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KRISTINE
Last Name:SHIVERS
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 1:697 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-1251
Mailing Address - Country:US
Mailing Address - Phone:234-564-7586
Mailing Address - Fax:
Practice Address - Street 1:250 DEBARTOLO PL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7004
Practice Address - Country:US
Practice Address - Phone:330-729-8380
Practice Address - Fax:330-729-8399
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207PH0002X363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner