Provider Demographics
NPI:1720503113
Name:ALEXANDER, JAIILYN DOMINIQUE
Entity Type:Individual
Prefix:
First Name:JAIILYN
Middle Name:DOMINIQUE
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 1:2361 CANAL BAY WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-8319
Mailing Address - Country:US
Mailing Address - Phone:614-290-8188
Mailing Address - Fax:
Practice Address - Street 1:2361 CANAL BAY WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-8319
Practice Address - Country:US
Practice Address - Phone:614-290-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH82-2404216OtherPROVIDER DODD IDENTIFICATION NUMBER