Provider Demographics
NPI:1235930314
Name:PHOENIX, ALANNA MADISON
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:MADISON
Last Name:PHOENIX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-2211
Mailing Address - Country:US
Mailing Address - Phone:816-383-4001
Mailing Address - Fax:
Practice Address - Street 1:2238 N 22ND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64505-2211
Practice Address - Country:US
Practice Address - Phone:816-383-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program