Provider Demographics
NPI:1447914973
Name:ALICEA, KARI ANDREA
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:ANDREA
Last Name:ALICEA
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 1:133 LA BONNE VIE DR W APT F
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4561
Mailing Address - Country:US
Mailing Address - Phone:631-504-8471
Mailing Address - Fax:
Practice Address - Street 1:133 LA BONNE VIE DR W APT F
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4561
Practice Address - Country:US
Practice Address - Phone:631-504-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812702163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse