Provider Demographics
NPI:1154942159
Name:PROSSER, ALEXANDRA DAY (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DAY
Last Name:PROSSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:DAY
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-2542
Mailing Address - Country:US
Mailing Address - Phone:419-433-6117
Mailing Address - Fax:419-433-7226
Practice Address - Street 1:808 MAIN ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-2542
Practice Address - Country:US
Practice Address - Phone:419-433-6117
Practice Address - Fax:419-433-7226
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.143020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program