Provider Demographics
NPI:1922710714
Name:LAVERE, ALEXA RILEIGH
Entity Type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:RILEIGH
Last Name:LAVERE
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 1:633 FROM RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3514
Mailing Address - Country:US
Mailing Address - Phone:866-467-1770
Mailing Address - Fax:
Practice Address - Street 1:633 FROM RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3514
Practice Address - Country:US
Practice Address - Phone:866-467-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty