Individual
ALEXANDRA MODELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
5225 N IRONWOOD RD STE 102, GLENDALE, WI 53217-4909
(414) 491-2084
Mailing address
5225 N IRONWOOD RD STE 102, GLENDALE, WI 53217-4909
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
948-55
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NEITHER MEDICARE OR MEDICAID, AS ACUPUNCTURE IS NOT COVERED
—
Enumeration date
01/30/2020
Last updated
01/30/2020
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