Provider Demographics
NPI:1144795782
Name:LOPER, ALICIA (CRNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LOPER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-0393
Mailing Address - Country:US
Mailing Address - Phone:215-660-9003
Mailing Address - Fax:215-257-1800
Practice Address - Street 1:345 E MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1114
Practice Address - Country:US
Practice Address - Phone:215-242-5000
Practice Address - Fax:215-242-5086
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019395363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology