Provider Demographics
NPI:1689445249
Name:ANDERSON, ALEXIS DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SPRINGFIELD STREET
Mailing Address - Street 2:APT. 106
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:319-371-0262
Mailing Address - Fax:
Practice Address - Street 1:1311 SPRINGFIELD STREET
Practice Address - Street 2:APT. 106
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:319-371-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95236082163WC1400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC1400XNursing Service ProvidersRegistered NurseCollege HealthGroup - Multi-Specialty