1346442365 NPI number — MRS. ALEXIS FUSELIER HOLDER PA

Table of content: MRS. ALEXIS FUSELIER HOLDER PA (NPI 1346442365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346442365 NPI number — MRS. ALEXIS FUSELIER HOLDER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDER
Provider First Name:
ALEXIS
Provider Middle Name:
FUSELIER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUSELIER
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346442365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 PARK BEND DR
Provider Second Line Business Mailing Address:
BLDG # 3, SUITE 300
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78758-5387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-467-2727
Provider Business Mailing Address Fax Number:
512-873-7576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 PARK BEND DR
Provider Second Line Business Practice Location Address:
BLDG # 3, SUITE 300
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-5387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-467-2727
Provider Business Practice Location Address Fax Number:
512-873-7576
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA03794 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA03794 . This is a "PA LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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