Provider Demographics
NPI:1093039257
Name:NICULAESCU, ALINA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:NICULAESCU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:LAPADAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 BRISBOYS RD
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-9398
Mailing Address - Country:US
Mailing Address - Phone:208-610-8186
Mailing Address - Fax:
Practice Address - Street 1:606 N 3RD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1594
Practice Address - Country:US
Practice Address - Phone:208-965-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.60128502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant