Provider Demographics
NPI:1881107894
Name:NEYNABER, ALEXA KOCH (NMD, ND)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:KOCH
Last Name:NEYNABER
Suffix:
Gender:F
Credentials:NMD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 E COPPER POINT DR STE 206
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9290
Mailing Address - Country:US
Mailing Address - Phone:208-425-7627
Mailing Address - Fax:
Practice Address - Street 1:3023 E COPPER POINT DR STE 206
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9290
Practice Address - Country:US
Practice Address - Phone:208-957-7627
Practice Address - Fax:208-600-6922
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNMD-0022175F00000X
WANT60807861175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath