Provider Demographics
NPI:1043039050
Name:MISCO, ALEXIS ANNE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANNE
Last Name:MISCO
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 1:8557 W HAMPDEN AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4795
Mailing Address - Country:US
Mailing Address - Phone:920-829-5688
Mailing Address - Fax:
Practice Address - Street 1:9101 E KENYON AVE STE 3200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1855
Practice Address - Country:US
Practice Address - Phone:920-829-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program