Provider Demographics
NPI:1578258539
Name:ZACKERY, ALEXSUS
Entity Type:Individual
Prefix:
First Name:ALEXSUS
Middle Name:
Last Name:ZACKERY
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 1:570 BELLERIVE RD APT 439
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4236
Mailing Address - Country:US
Mailing Address - Phone:202-290-4791
Mailing Address - Fax:
Practice Address - Street 1:570 BELLERIVE RD APT 439
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4236
Practice Address - Country:US
Practice Address - Phone:202-290-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant