Basic Information
| Provider Information | |||||||||
| NPI: | 1922479195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONSTAD | ||||||||
| FirstName: | ALEXA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 MAPLE LANE | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156855500 | ||||||||
| FaxNumber: | 7156824022 | ||||||||
| Practice Location | |||||||||
| Address1: | MEMORIAL MEDICAL CENTER, INC | ||||||||
| Address2: | 1615 MAPLE LANE | ||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156855500 | ||||||||
| FaxNumber: | 7156824022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2015 | ||||||||
| LastUpdateDate: | 02/26/2018 | ||||||||
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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 | 163W00000X | 167904-30 | WI | N | Nursing Service Providers | Registered Nurse | 363L00000X | 6684-33 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | 6684-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.