Provider Demographics
NPI:1235662081
Name:VICK, ALEXANDRA (CNA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:VICK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18621 29TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-4323
Mailing Address - Country:US
Mailing Address - Phone:253-820-5572
Mailing Address - Fax:
Practice Address - Street 1:18621 29TH AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-4323
Practice Address - Country:US
Practice Address - Phone:253-820-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-08
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60495441314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility