Doctor Name: | ROBERTA ALEXIS |
NPI Number: | 1043594203 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CN0028910941 |
Business Practice Address: | 59 Paradise Cir Douglasville, GA - 301345215 |
Business Phone Number: | 4045379295 |
Business Fax Number: | |
Mailing Address: | 59 Paradise Cir, DOUGLASVILLE |
State: | GA |
Postal Code: | 301345215 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/06/2011 |
NPI Last Update Date: | 10/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WH0200X |
License Number: | CN0028910941 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Home Health |
Taxonomy Definition: |