Provider Demographics
NPI:1790060515
Name:ECONOMY, ALEXANDRA MARIE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:ECONOMY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 W SERVICE DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2512
Mailing Address - Country:US
Mailing Address - Phone:507-452-5411
Mailing Address - Fax:507-452-9592
Practice Address - Street 1:1475 W SERVICE DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-2512
Practice Address - Country:US
Practice Address - Phone:507-452-5411
Practice Address - Fax:507-452-9592
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered