Provider Demographics
NPI:1871275776
Name:FAASSE, ALEXANDRA JO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:JO
Last Name:FAASSE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2076 BRANDON DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4760
Mailing Address - Country:US
Mailing Address - Phone:616-780-9868
Mailing Address - Fax:
Practice Address - Street 1:4100 EMBASSY DR SE STE 400
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2416
Practice Address - Country:US
Practice Address - Phone:616-957-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-11-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant