Provider Demographics
NPI:1356955520
Name:WEATHERLY, ALEXANDRA ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:WEATHERLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:ELIZABETH
Other - Last Name:WEATHERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2001 RICHMOND HWY # 800
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 RICHMOND HWY # 800
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3603
Practice Address - Country:US
Practice Address - Phone:571-257-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program