Provider Demographics
NPI:1033974910
Name:LANDRESS, ALICIA NICOLE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:LANDRESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3118
Mailing Address - Country:US
Mailing Address - Phone:803-426-8092
Mailing Address - Fax:
Practice Address - Street 1:107 E MARION AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2935
Practice Address - Country:US
Practice Address - Phone:803-426-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier