Provider Demographics
NPI:1801495189
Name:ALEXIS, MARIE C (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19304 HORACE HARDING EXPY APT 2F
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2820
Mailing Address - Country:US
Mailing Address - Phone:718-276-7935
Mailing Address - Fax:
Practice Address - Street 1:19304 HORACE HARDING EXPY APT 2F
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2820
Practice Address - Country:US
Practice Address - Phone:718-276-7935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF363LF0000X
NYF346470-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNONEMedicaid