Basic Information
| Provider Information | |||||||||
| NPI: | 1972172286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHENEY | ||||||||
| FirstName: | ALEXA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 OAK DR | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD CENTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062501516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604283199 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
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| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2021 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 318074 | NC | N | Nursing Service Providers | Registered Nurse | 367500000X | 12.010068 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.