Provider Demographics
NPI:1457179558
Name:EITEL, ALEXIS MICHELLE (PA-S2)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MICHELLE
Last Name:EITEL
Suffix:
Gender:F
Credentials:PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13617 N EAGLE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7069
Mailing Address - Country:US
Mailing Address - Phone:321-626-6270
Mailing Address - Fax:
Practice Address - Street 1:14455 W VAN BUREN ST STE 100
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9209
Practice Address - Country:US
Practice Address - Phone:623-925-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant