Provider Demographics
NPI:1770301608
Name:MAGERS, ALEXIS KIM
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KIM
Last Name:MAGERS
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 1:2397 NE 106TH AVE APT 1312
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-8249
Mailing Address - Country:US
Mailing Address - Phone:541-231-6835
Mailing Address - Fax:
Practice Address - Street 1:2397 NE 106TH AVE APT 1312
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8249
Practice Address - Country:US
Practice Address - Phone:541-231-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR124Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No124Q00000XDental ProvidersDental Hygienist