Provider Demographics
NPI:1073875241
Name:STIDFOLE, ALICIA K (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:K
Last Name:STIDFOLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:K
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-5118
Practice Address - Fax:717-782-5854
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN575948367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered