Provider Demographics
NPI:1144627829
Name:MACPHERSON, ALIA CRYSTAL (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:ALIA
Middle Name:CRYSTAL
Last Name:MACPHERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2292
Mailing Address - Country:US
Mailing Address - Phone:978-281-1500
Mailing Address - Fax:978-282-3611
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2292
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:978-282-3611
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5991363LF0000X
MARN2305963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2305963Medicaid