Provider Demographics
NPI:1538588942
Name:RODRIGUEZ, ALICIA PATRICE (LPN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:PATRICE
Last Name:RODRIGUEZ
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 1:5 GAYMORE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFF STA
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1309
Mailing Address - Country:US
Mailing Address - Phone:631-626-3594
Mailing Address - Fax:
Practice Address - Street 1:5 GAYMORE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-1309
Practice Address - Country:US
Practice Address - Phone:631-626-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312451-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse