Provider Demographics
NPI:1194490300
Name:WILLIAMSON, ALEXA ANNE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:ANNE
Last Name:WILLIAMSON
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 1:4409 STONE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1227
Mailing Address - Country:US
Mailing Address - Phone:814-464-3040
Mailing Address - Fax:
Practice Address - Street 1:2496 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3293
Practice Address - Country:US
Practice Address - Phone:815-754-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062702363A00000X
OH50.007742RX363A00000X
IL085.010177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant