Provider Demographics
NPI:1306836697
Name:BARTLETT, ALICA KELLY (WHNP)
Entity Type:Individual
Prefix:MS
First Name:ALICA
Middle Name:KELLY
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4298 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5805
Mailing Address - Country:US
Mailing Address - Phone:847-688-5568
Mailing Address - Fax:847-688-4413
Practice Address - Street 1:1020 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3102
Practice Address - Country:US
Practice Address - Phone:847-688-5568
Practice Address - Fax:847-688-4413
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561349363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health