1619099397 NPI number — MYRNA I ALICEA CRNP

Table of content: MYRNA I ALICEA CRNP (NPI 1619099397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619099397 NPI number — MYRNA I ALICEA CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALICEA
Provider First Name:
MYRNA
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALICEA-MACALINDONG
Provider Other First Name:
MYRNA
Provider Other Middle Name:
I
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619099397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-710-7037
Provider Business Mailing Address Fax Number:
215-710-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 LANGHORNE NEWTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-750-7818
Provider Business Practice Location Address Fax Number:
215-752-0436
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP009402 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1025050510002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9004062 . This is a "CIGNA PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7675993 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P01417918 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SP009402 . This is a "CRNP STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30221870 . This is a "KEYSTONE FIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3114453 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RN526618L . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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