Provider Demographics
NPI:1366191728
Name:ALEXANDER, ADRENA
Entity type:Individual
Prefix:
First Name:ADRENA
Middle Name:
Last Name:ALEXANDER
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 1:1367 S COUNTRY CLUB DR UNIT 1075
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5290
Mailing Address - Country:US
Mailing Address - Phone:313-740-6663
Mailing Address - Fax:
Practice Address - Street 1:1457 W SOUTHERN AVE STE 5
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4852
Practice Address - Country:US
Practice Address - Phone:602-386-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide