Provider Demographics
NPI:1275937963
Name:JORGENSON, ALEXIS DAWKINS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:DAWKINS
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:ALEXIS
Other - Last Name:DAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1105 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3107
Mailing Address - Country:US
Mailing Address - Phone:617-777-3885
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-792-4121
Practice Address - Fax:781-681-1364
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61508702367500000X
MARN2296957163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400220178Medicare PIN