Provider Demographics
NPI:1790016723
Name:NORTHUP, ALEXANDRA JEAN (LMT, RYT)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:JEAN
Last Name:NORTHUP
Suffix:
Gender:F
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 NE DEKUM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6637
Mailing Address - Country:US
Mailing Address - Phone:503-806-5130
Mailing Address - Fax:
Practice Address - Street 1:4940 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5042
Practice Address - Country:US
Practice Address - Phone:503-806-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator