Provider Demographics
NPI:1326725078
Name:LONCHAR, ALICIA MICHELE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELE
Last Name:LONCHAR
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 1:11 GULLETTE LN
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5255
Mailing Address - Country:US
Mailing Address - Phone:775-762-8751
Mailing Address - Fax:
Practice Address - Street 1:11 GULLETTE LN
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5255
Practice Address - Country:US
Practice Address - Phone:775-762-8751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV182126228Medicaid
WV125553494Medicaid
WV1356607394Medicaid