Provider Demographics
NPI:1104448851
Name:BACHMAN-WILLIAMS, ALEXANDRA L
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:BACHMAN-WILLIAMS
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:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:TIMBER LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57656-0409
Mailing Address - Country:US
Mailing Address - Phone:701-208-1992
Mailing Address - Fax:
Practice Address - Street 1:24337 US HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-7770
Practice Address - Country:US
Practice Address - Phone:605-965-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant