Basic Information
| Provider Information | |||||||||
| NPI: | 1104559483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISCHOF | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ERICKSON | ||||||||
| OtherFirstName: | ALEXIS | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14239 W BELL RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853742471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235840800 | ||||||||
| FaxNumber: | 6235840312 | ||||||||
| Practice Location | |||||||||
| Address1: | 14239 W BELL RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853742471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235840800 | ||||||||
| FaxNumber: | 6235840312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2022 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.