ALEXIS DEITZ (NPI# 1669030177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669030177 |
| Entity Type | Individual |
| Full Name | ALEXIS DEITZ |
| Credential | PA-C |
| Practice Address |
574 Middle Tpke E Manchester CT 06040-3730 |
| Mailing Address |
600 Andrews Way Apt 307 South Windsor CT 06074-9603 |
| Practice Telephone | 8606464334 |
| Mailing Telephone | 8606464334 |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-07-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
574 MIDDLE TPKE E |
| City | MANCHESTER |
| State | CT |
| Zip Code | 06040-3730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073522991 | Barbara Louise Phillips | Family Medicine | 574 Middle Tpke E, Manchester, CT 06040-3730 | 2006-08-07 |
| 1992232813 | Simone V Gorski | Family Medicine | 574 Middle Tpke E, Manchester, CT 06040-3730 | 2017-05-23 |
| 1730566381 | Family Medicine Center | Physician Assistant | 574 Middle Tpke E, Manchester, CT 06040-3730 | 2015-05-04 |
| 1427067339 | Martin Mark Keibel | Family Medicine | 574 Middle Tpke E, Manchester, CT 06040-3730 | 2006-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710501333 | Mackenzie Lawler | Social Worker | 200 W. Center Street, Suite C-2-6, Manchester, CT 06040 | 2020-05-29 |
| 1386288009 | Monica Diaz | Social Worker | 117 East Center Street, Suite A1, Manchester, CT 06040 | 2019-11-06 |
| 1346881596 | Sheryl Andrine Henry | Technician | 185 Pine Street, Apt 014, Manchester, CT 06040 | 2019-09-30 |
| 1811550304 | Edward Wahn Lee | Student in an Organized Health Care Education/Training Program | 130 Hartford Road, Manchester, CT 06040 | 2019-04-19 |
| 1538689534 | Bernard Ashirifie | Counselor | 869 Main Street, Apt 3, Manchester, CT 06040 | 2017-06-21 |
| 1497275697 | Justin David Chung | Dentist | 483 Middle Tpke W Ste 209, Manchester, CT 06040 | 2017-06-20 |
| 1114473436 | Amanda Edgar | Counselor | 469 Center Street, Manchester, CT 06040 | 2016-08-28 |
| 1760831366 | Samantha Micael | Marriage & Family Therapist | 200 West Center Street, Suite C-2-6, Manchester, CT 06040 | 2016-06-06 |
| 1962856179 | Odelia Brew | Nurse Practitioner | 256 Hackmatack Street, Manchester, CT 06040 | 2016-04-14 |
| 1306217765 | Stephen R Machattie | Social Worker | 843 Main St Ste 11, Manchester, CT 06040 | 2015-10-12 |
| Find all providers in zip 06040 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356729487 | Kelsey Wood | Physician Assistant | 574 Middle Turnpike East, Kelsey Wood, Manchester, CT 06040-3730 | 2015-05-08 |
| 1841626678 | Evan Patrick Dyer | Physician Assistant | 1415 Hillsboro Blvd Ste 106, Manchester, TN 37355-2599 | 2013-09-25 |
| 1528313350 | Stephanie Elaine Fangman | Physician Assistant | 709 W Main St Ste 3, Manchester, IA 52057-1526 | 2012-07-18 |
| 1932351673 | Michael Anthony Ascenzia | Physician Assistant | 360 Tolland Tpke Ste 1a, Manchester, CT 06042-1759 | 2008-10-14 |
| 1780747519 | Wendy Brown Jorgensen | Physician Assistant | 1053 Western Avenue, Manchester, ME 04351 | 2006-12-19 |
| 1770694945 | Briana Marie Peterson | Physician Assistant | 574 E Middle Tpke, Manchester, CT 06040-3730 | 2006-08-31 |
| 1245249010 | Holly Pelletier | Physician Assistant | 57 Webster St Ste 110, Manchester, NH 03104-2552 | 2006-08-07 |
| 1558396192 | Nancy E. Kalinski | Physician Assistant | 102 Bay St, Manchester, NH 03104-3008 | 2006-07-12 |
| 1790787323 | Paul Barlow | Physician Assistant | 1 Highlander Way Ste 4, Manchester, NH 03103-7404 | 2005-08-12 |
| 1083154926 | Kristen N Vautour | Physician Assistant | 100 Hitchcock Way, Manchester, NH 03104-4125 | 2017-02-25 |
| Find all providers in MANCHESTER | ||||
| City | MANCHESTER |
| Zip Code | 06040 |
Please comment or provide details below to improve the information on ALEXIS DEITZ.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.