Provider Demographics
NPI:1962389924
Name:LONGSTREET, ALEXIS MONET
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MONET
Last Name:LONGSTREET
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 1:1264 E 100TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3503
Mailing Address - Country:US
Mailing Address - Phone:234-650-2355
Mailing Address - Fax:
Practice Address - Street 1:1264 E 100TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3503
Practice Address - Country:US
Practice Address - Phone:234-650-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372500000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty