Provider Demographics
NPI:1922824630
Name:O'BRIAN, ALEXIS MACKENZIE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MACKENZIE
Last Name:O'BRIAN
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 1:2643 PLEASANT COLONY DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7126
Mailing Address - Country:US
Mailing Address - Phone:740-816-5733
Mailing Address - Fax:
Practice Address - Street 1:2643 PLEASANT COLONY DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7126
Practice Address - Country:US
Practice Address - Phone:740-816-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide