Provider Demographics
NPI:1700365962
Name:FLANAGAN, ALEXANDRA FAYE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:FAYE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIANDRA
Other - Middle Name:
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:943 N PLUM GROVE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4779
Mailing Address - Country:US
Mailing Address - Phone:847-952-9140
Mailing Address - Fax:
Practice Address - Street 1:943 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5177
Practice Address - Country:US
Practice Address - Phone:847-952-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant