Provider Demographics
NPI:1154937464
Name:LAM, ALEXIS LYNN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LYNN
Last Name:LAM
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 1:1697 MIDDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-7021
Mailing Address - Country:US
Mailing Address - Phone:304-359-8462
Mailing Address - Fax:
Practice Address - Street 1:1697 MIDDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-7021
Practice Address - Country:US
Practice Address - Phone:304-359-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant