Provider Demographics
NPI:1194713487
Name:ALEXANDER, CORALYN JILL (MD, PA)
Entity type:Individual
Prefix:
First Name:CORALYN
Middle Name:JILL
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:CORALYN
Other - Middle Name:J
Other - Last Name:HERTZBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:235 E ROWAN AVE STE 220
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-474-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM69402084P0800X
WAMD000297412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDE757OtherBLUECROSS
ID10001359OtherBLUESHIELD
ID804004500Medicaid