Basic Information
| Provider Information | |||||||||
| NPI: | 1386984987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FINE | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUND VALLEY DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356556607 | ||||||||
| FaxNumber: | 4356552388 | ||||||||
| Practice Location | |||||||||
| Address1: | 3451 S 5600 W | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WEST VALLEY CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841201301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019570900 | ||||||||
| FaxNumber: | 8019664384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2013 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085-004849 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 8894812-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.