Provider Demographics
NPI:1063270502
Name:BLANK, ALICIA R (RN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
Last Name:BLANK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:8444 N 90TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4437
Mailing Address - Country:US
Mailing Address - Phone:602-248-8886
Mailing Address - Fax:602-854-0504
Practice Address - Street 1:2040 ROSEBUD DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6294
Practice Address - Country:US
Practice Address - Phone:406-969-4812
Practice Address - Fax:406-969-4814
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MTRN-96920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse