Provider Demographics
NPI:1245775154
Name:BARENSE, ALEXANDRIA NICOLE
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:BARENSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:BARENSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3756 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9354
Mailing Address - Country:US
Mailing Address - Phone:616-405-8314
Mailing Address - Fax:
Practice Address - Street 1:41521 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1803
Practice Address - Country:US
Practice Address - Phone:248-299-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB652044630861247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other