Healthcare Provider Details

I. General information

NPI: 1689059909
Provider Name (Legal Business Name): ALICIA M. PRICE, AOCNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3664 SKYGLADE DR
ELGIN IL
60124-5722
US

IV. Provider business mailing address

PO BOX 6602
ELGIN IL
60121-6602
US

V. Phone/Fax

Practice location:
  • Phone: 646-918-0085
  • Fax:
Mailing address:
  • Phone: 707-378-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA M PRICE
Title or Position: OWNER
Credential: AOCNP
Phone: 704-378-9673