Provider Demographics
NPI:1124760947
Name:ROUD, ALICIA
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:
Last Name:ROUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11080 VAUGHN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9315
Mailing Address - Country:US
Mailing Address - Phone:330-329-6575
Mailing Address - Fax:
Practice Address - Street 1:11080 VAUGHN AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4460
Practice Address - Country:US
Practice Address - Phone:330-329-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide