Provider Demographics
NPI:1710710496
Name:WASHINGTON, ALEXXIS
Entity type:Individual
Prefix:
First Name:ALEXXIS
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAPLE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5140
Mailing Address - Country:US
Mailing Address - Phone:413-420-2200
Mailing Address - Fax:413-539-9472
Practice Address - Street 1:230 MAPLE ST STE 1
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5140
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:413-539-9472
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2372636363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner