Provider Demographics
NPI:1649670233
Name:BOHN, ALEXANDRA L (LMP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:BOHN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4631
Mailing Address - Country:US
Mailing Address - Phone:509-630-1787
Mailing Address - Fax:
Practice Address - Street 1:330 KING ST STE 9
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2857
Practice Address - Country:US
Practice Address - Phone:509-630-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60481174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist