Healthcare Provider Details

I. General information

NPI: 1518678036
Provider Name (Legal Business Name): ALICIA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TRACY WAY STE 100
CHARLESTON WV
25311-1280
US

IV. Provider business mailing address

400 TRACY WAY STE 100
CHARLESTON WV
25311-1280
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-0205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number86504
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: