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Individual
MYRNA I ALICEA
Active
Individual
MYRNA I ALICEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP009402
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025050510002
—
PA
01
—
30221870
KEYSTONE FIRST
PA
01
—
3114453
HIGHMARK BLUE SHIELD
PA
01
—
7675993
AETNA
PA
01
—
9004062
CIGNA PA
PA
01
—
P01417918
RAILROAD MEDICARE
PA
01
—
RN526618L
REGISTERED NURSE LICENSE
PA
01
—
SP009402
CRNP STATE LICENSE
PA
Enumeration date
04/04/2007
Last updated
08/10/2018
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