Provider Demographics
NPI:1366943474
Name:JONES, ALEXIS J
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:J
Other - Last Name:BOGDANOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 HUNNEWELL RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9586
Mailing Address - Country:US
Mailing Address - Phone:207-749-9553
Mailing Address - Fax:
Practice Address - Street 1:27 GORHAM ROAD
Practice Address - Street 2:SUITE 201 MAILBOX #6
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-749-9553
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1394133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered