Basic Information
| Provider Information | |||||||||
| NPI: | 1194074864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 NEW YORK AVE NE | ||||||||
| Address2: | 117 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200021848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024800813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1818 NEW YORK AVE NE | ||||||||
| Address2: | 117 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200021848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024800813 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2012 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | HHA3957 | DC | Y | Nursing Service Related Providers | Home Health Aide |
No ID Information.