Provider Demographics
NPI:1275867210
Name:CORRADINO, ALICIA M
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:CORRADINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4465
Mailing Address - Country:US
Mailing Address - Phone:315-561-3725
Mailing Address - Fax:
Practice Address - Street 1:3561 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4465
Practice Address - Country:US
Practice Address - Phone:315-561-3725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse