Provider Demographics
NPI:1043410012
Name:STUART, ALICA BETH (RPA-C)
Entity Type:Individual
Prefix:MISS
First Name:ALICA
Middle Name:BETH
Last Name:STUART
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:ALICA
Other - Middle Name:BETH
Other - Last Name:HERMANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3615 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3444
Mailing Address - Country:US
Mailing Address - Phone:716-675-7676
Mailing Address - Fax:
Practice Address - Street 1:3615 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3444
Practice Address - Country:US
Practice Address - Phone:716-675-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011942363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical