Provider Demographics
NPI:1811447808
Name:KOLODY, ALEXANDRIA MARY (LPN)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARY
Last Name:KOLODY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:KOLODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4255 MACLEAY RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5806
Mailing Address - Country:US
Mailing Address - Phone:785-418-7098
Mailing Address - Fax:
Practice Address - Street 1:2035 DAVCOR ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1595
Practice Address - Country:US
Practice Address - Phone:503-585-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201509376LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse