Provider Demographics
NPI:1316914369
Name:ALEXANDER, HOLLY ELIZABETH (PA)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 DELAWARE AVE
Mailing Address - Street 2:205B
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-1400
Mailing Address - Country:US
Mailing Address - Phone:740-387-4578
Mailing Address - Fax:740-387-8638
Practice Address - Street 1:1069 DELAWARE AVE
Practice Address - Street 2:205B
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1400
Practice Address - Country:US
Practice Address - Phone:740-387-4578
Practice Address - Fax:740-387-8638
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FRPA24331Medicare ID - Type Unspecified
Q36283Medicare UPIN