Provider Demographics
NPI:1558250449
Name:STAATS, ALICIA LYNN
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:STAATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICA
Other - Middle Name:LYNN
Other - Last Name:DENGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:19103 BROADFORD RD
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-3909
Mailing Address - Country:US
Mailing Address - Phone:814-720-3598
Mailing Address - Fax:814-720-3598
Practice Address - Street 1:600 WESLEY WAY
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-9413
Practice Address - Country:US
Practice Address - Phone:814-720-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033235363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health