Provider Demographics
NPI:1578847034
Name:WHITE, ALICIA LUTGARDA (NP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LUTGARDA
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-531-5638
Practice Address - Fax:717-531-0983
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024177120363L00000X, 363LA2200X
NE114325363LA2200X
PASP031774363LA2200X
NE114628363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology