Provider Demographics
NPI:1912651191
Name:SHROCK, ALEXIS L
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:L
Last Name:SHROCK
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 1:727 N 950 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3885
Mailing Address - Country:US
Mailing Address - Phone:801-710-1156
Mailing Address - Fax:
Practice Address - Street 1:727 N 950 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3885
Practice Address - Country:US
Practice Address - Phone:801-710-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTL-305372174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN