Provider Demographics
NPI:1831597947
Name:SMITH, ALEXANDRA CALEY (RN, CNS)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:CALEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:MARIE
Other - Last Name:CALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:60236 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9449
Mailing Address - Country:US
Mailing Address - Phone:503-702-9644
Mailing Address - Fax:
Practice Address - Street 1:60236 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9449
Practice Address - Country:US
Practice Address - Phone:503-702-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200642382RN163W00000X
WARN60187804163W00000X
OR201404022CNS163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163W00000XNursing Service ProvidersRegistered Nurse