Provider Demographics
NPI:1215677984
Name:DUELL, ALEXIS DOMINIQUE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DOMINIQUE
Last Name:DUELL
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 1:815 E WILLOUGHBY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6623
Mailing Address - Country:US
Mailing Address - Phone:517-648-4170
Mailing Address - Fax:
Practice Address - Street 1:815 E WILLOUGHBY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6623
Practice Address - Country:US
Practice Address - Phone:517-648-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant