Provider Demographics
NPI:1053694190
Name:DRENNEN, ALEXIS VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:VICTORIA
Last Name:DRENNEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:VICTORIA
Other - Last Name:PINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE1402
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:267-339-3500
Mailing Address - Fax:
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:269-339-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant