Provider Demographics
NPI:1619924487
Name:LADUKE, ALICIA K (PAC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:K
Last Name:LADUKE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:K
Other - Last Name:BRIMHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:165 W 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5507
Mailing Address - Country:US
Mailing Address - Phone:480-216-8621
Mailing Address - Fax:
Practice Address - Street 1:165 W 7TH ST S
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5507
Practice Address - Country:US
Practice Address - Phone:480-216-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3130363A00000X
MT544363A00000X
DEC5-0000736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant