Provider Demographics
NPI:1821703059
Name:IDZIAK, ALEXANDRIA L
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:L
Last Name:IDZIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 CROOKS RD APT 35
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4508
Mailing Address - Country:US
Mailing Address - Phone:419-654-1067
Mailing Address - Fax:
Practice Address - Street 1:3905 CROOKS RD APT 35
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4508
Practice Address - Country:US
Practice Address - Phone:419-654-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula