Provider Demographics
NPI:1588173900
Name:LICA, KATRINA HELEN
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:HELEN
Last Name:LICA
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 1:140 E 17TH ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3418
Mailing Address - Country:US
Mailing Address - Phone:954-649-0289
Mailing Address - Fax:
Practice Address - Street 1:140 E 17TH ST APT 6A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3418
Practice Address - Country:US
Practice Address - Phone:954-649-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program