Provider Demographics
NPI:1184491425
Name:EVANS, ALEXANDRA (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:VENEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:517 TRUITT DR
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9261
Mailing Address - Country:US
Mailing Address - Phone:860-921-6528
Mailing Address - Fax:
Practice Address - Street 1:517 TRUITT DR
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9261
Practice Address - Country:US
Practice Address - Phone:860-921-6528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program