Provider Demographics
NPI:1588553903
Name:WADDELL, ALEXIS ANN (MAOL)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ANN
Last Name:WADDELL
Suffix:
Gender:F
Credentials:MAOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 W AUGUSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2510
Mailing Address - Country:US
Mailing Address - Phone:773-699-4722
Mailing Address - Fax:
Practice Address - Street 1:5834 W AUGUSTA BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2510
Practice Address - Country:US
Practice Address - Phone:773-699-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula