Provider Demographics
NPI:1215526413
Name:LIDGE, ALICEMAE
Entity type:Individual
Prefix:
First Name:ALICEMAE
Middle Name:
Last Name:LIDGE
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 1:932 KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2816
Mailing Address - Country:US
Mailing Address - Phone:330-962-9944
Mailing Address - Fax:
Practice Address - Street 1:932 KELLY AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2816
Practice Address - Country:US
Practice Address - Phone:330-962-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty