Healthcare Provider Details

I. General information

NPI: 1619482205
Provider Name (Legal Business Name): ALICIA MARIE PARKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # STREET3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

1 JENYFER CT
SHELTON CT
06484-5632
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-400-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9474040
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number117969
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11737
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: