1942678933 NPI number — DR. ALICIA COLLEEN NANCE AU.D.

Table of content: DR. ALICIA COLLEEN NANCE AU.D. (NPI 1942678933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942678933 NPI number — DR. ALICIA COLLEEN NANCE AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NANCE
Provider First Name:
ALICIA
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942678933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3805 E BELL RD
Provider Second Line Business Mailing Address:
STE 5800
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-688-6500
Provider Business Mailing Address Fax Number:
623-889-0836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3805 E BELL RD
Provider Second Line Business Practice Location Address:
STE. 5800
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-688-6500
Provider Business Practice Location Address Fax Number:
236-899-0836
Provider Enumeration Date:
09/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA9881 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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