Provider Demographics
NPI:1306524483
Name:WIRTH, ALEXIS NICOLE (PA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NICOLE
Last Name:WIRTH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 DENVER WEST CIR APT 1305
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3293
Mailing Address - Country:US
Mailing Address - Phone:608-279-3017
Mailing Address - Fax:
Practice Address - Street 1:2801 PURCELL ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3551
Practice Address - Country:US
Practice Address - Phone:303-558-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical