Provider Demographics
NPI:1043864077
Name:MEMBRINO, ALEXIS (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MEMBRINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WASHINGTON AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3805
Mailing Address - Country:US
Mailing Address - Phone:570-591-5159
Mailing Address - Fax:
Practice Address - Street 1:169 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-3603
Practice Address - Country:US
Practice Address - Phone:570-491-0126
Practice Address - Fax:570-230-0013
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant