Provider Demographics
NPI:1861972226
Name:SHIREY, ALEXANDRA ELAINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ELAINE
Last Name:SHIREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22664 STATE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-6365
Mailing Address - Country:US
Mailing Address - Phone:740-858-6690
Mailing Address - Fax:740-858-6693
Practice Address - Street 1:22664 STATE ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-6365
Practice Address - Country:US
Practice Address - Phone:740-858-6690
Practice Address - Fax:740-858-6693
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166945164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1548782816Medicaid