Provider Demographics
NPI:1740679885
Name:WINDER, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:WINDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10757 S RIVER FRONT PKWY
Mailing Address - Street 2:#110
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3545
Mailing Address - Country:US
Mailing Address - Phone:801-635-9619
Mailing Address - Fax:
Practice Address - Street 1:10757 S RIVER FRONT PKWY
Practice Address - Street 2:#110
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3545
Practice Address - Country:US
Practice Address - Phone:801-635-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
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No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant