Healthcare Provider Details

I. General information

NPI: 1194183095
Provider Name (Legal Business Name): ALICIA WERNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA SWEARINGEN

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY UNIT 25
SPARKS NV
89431-5560
US

IV. Provider business mailing address

480 GALLETTI WAY UNIT 25
SPARKS NV
89431-5560
US

V. Phone/Fax

Practice location:
  • Phone: 756-882-0017
  • Fax:
Mailing address:
  • Phone: 775-688-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number819251
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: