Provider Demographics
NPI:1528299161
Name:MILAN, ALYCIA MICHELLE (LIC PRACTICAL NURSE)
Entity type:Individual
Prefix:MRS
First Name:ALYCIA
Middle Name:MICHELLE
Last Name:MILAN
Suffix:
Gender:F
Credentials:LIC PRACTICAL NURSE
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1201 S. PROCTOR
Mailing Address - Street 2:COMPREHENSIVE MENTAL HEALTH PEARL STREET CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465
Mailing Address - Country:US
Mailing Address - Phone:253-396-5930
Mailing Address - Fax:253-566-2252
Practice Address - Street 1:1201 S. PROCTOR
Practice Address - Street 2:COMPREHENSIVE MENTAL HEALTH PEARL STREET CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465
Practice Address - Country:US
Practice Address - Phone:253-396-5930
Practice Address - Fax:253-566-2252
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALP60012934164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse