Provider Demographics
NPI:1609597665
Name:CANADA-MARCUS, ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:CANADA-MARCUS
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 1:15069 BROADWATER WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1786
Mailing Address - Country:US
Mailing Address - Phone:202-716-9686
Mailing Address - Fax:
Practice Address - Street 1:15069 BROADWATER WAY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1786
Practice Address - Country:US
Practice Address - Phone:202-716-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No385H00000XRespite Care FacilityRespite Care