Individual
ALEXIS SHAWNTEL VIVIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 KNEELAND ST, BOSTON, MA 02111-1527
(704) 490-1039
Mailing address
665 WASHINGTON ST UNIT 2115, BOSTON, MA 02111-1653
(704) 490-1039
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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