Provider Demographics
NPI:1336741321
Name:SMITH, ALEXZANDRA
Entity Type:Individual
Prefix:
First Name:ALEXZANDRA
Middle Name:
Last Name:SMITH
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 1:4469 HAWK RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-9653
Mailing Address - Country:US
Mailing Address - Phone:937-408-1445
Mailing Address - Fax:
Practice Address - Street 1:4469 HAWK RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:OH
Practice Address - Zip Code:43044-9653
Practice Address - Country:US
Practice Address - Phone:937-408-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist