Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 0101264717 | VA |
N | 207VX0000X | Obstetrician | D0085805 | MD |
NPI | 1144648502 |
---|---|
Provider Name | Alexis D Light |
First Address | Alexandria, VA 22314-4252 |
Second Address | Alexandria, VA 22314-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 08/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101264717 | STATE LICENSE (01) | VA |