Provider Demographics
NPI:1649987801
Name:ALEXANDER, DENISE DIANE
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:DIANE
Last Name:ALEXANDER
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 1:10055 S YATES BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-5366
Mailing Address - Country:US
Mailing Address - Phone:312-889-8605
Mailing Address - Fax:
Practice Address - Street 1:10055 S YATES BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-5366
Practice Address - Country:US
Practice Address - Phone:312-889-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA42516459675347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle