Provider Demographics
NPI:1619775152
Name:WILLIS, ALEXANDRIA A
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:A
Last Name:WILLIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4133
Mailing Address - Country:US
Mailing Address - Phone:216-645-3970
Mailing Address - Fax:
Practice Address - Street 1:83 SAPPHIRE LN
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4133
Practice Address - Country:US
Practice Address - Phone:216-645-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver