Provider Demographics
NPI:1659917680
Name:MILLETT, ALEXANDRA DEANNE (CNM)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DEANNE
Last Name:MILLETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 DAYTON AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6276
Mailing Address - Country:US
Mailing Address - Phone:651-272-3569
Mailing Address - Fax:
Practice Address - Street 1:1901 44TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1209
Practice Address - Country:US
Practice Address - Phone:612-338-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN421367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife