Individual
ALICIA P PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3400 WAKE FOREST RD, RALEIGH, NC 27609-7317
(919) 862-2731
(919) 862-2731
Mailing address
PO BOX 63362, CHARLOTTE, NC 28263-3362
(919) 620-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06796
NC
Other
Enumeration date
10/23/2012
Last updated
11/15/2016
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