Provider Demographics
NPI:1912667981
Name:CHIMAHUSKY, ALEXANDRA BRIANA (PA)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:BRIANA
Last Name:CHIMAHUSKY
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 1:23210 N 25T ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024
Mailing Address - Country:US
Mailing Address - Phone:570-573-4724
Mailing Address - Fax:
Practice Address - Street 1:13640 W PLAZA DEL RIO BLVC
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-876-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ8857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant