Provider Demographics
NPI:1538334362
Name:NAU, ALICIA MAYE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MAYE
Last Name:NAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20773 FROSTYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9635
Mailing Address - Country:US
Mailing Address - Phone:740-732-2619
Mailing Address - Fax:
Practice Address - Street 1:20773 FROSTYVILLE RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9635
Practice Address - Country:US
Practice Address - Phone:740-732-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106763164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2214624Medicaid