Provider Demographics
NPI:1962858498
Name:MAITLAND, ALEXIS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MAITLAND
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 1:13000 BUTTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILSONS
Mailing Address - State:VA
Mailing Address - Zip Code:23894-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13000 BUTTERWOOD LN
Practice Address - Street 2:
Practice Address - City:WILSONS
Practice Address - State:VA
Practice Address - Zip Code:23894-2560
Practice Address - Country:US
Practice Address - Phone:804-896-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management