Provider Demographics
NPI:1063391191
Name:GREEN, ALEXA HARCOURT (RN)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:HARCOURT
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4507
Mailing Address - Country:US
Mailing Address - Phone:323-915-2221
Mailing Address - Fax:323-915-2221
Practice Address - Street 1:222 S HILL ST FL 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3508
Practice Address - Country:US
Practice Address - Phone:213-473-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95308114163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health