Provider Demographics
NPI:1215320874
Name:ALEXANDER, MICA AYANA (CNM)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:AYANA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MICA
Other - Middle Name:A
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2687
Mailing Address - Country:US
Mailing Address - Phone:937-523-1000
Mailing Address - Fax:937-399-7355
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2687
Practice Address - Country:US
Practice Address - Phone:937-523-1000
Practice Address - Fax:937-399-7355
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245131367A00000X
OHAPRN.CNM.15882367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217023Medicaid
GARN245131OtherLICENSE
OHH588330OtherMEDICARE OPG