Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125067433 | IL |
Y | 2080A0000X | Adolescent Medicine | 6899720 | WI |
NPI | 1285028886 |
---|---|
Provider Name | Dr. Alexandria Holliday |
First Address | Park Ridge, IL 60068-1110 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 15/12/2021 |