Provider Demographics
NPI:1407912686
Name:EPHRAIM, ALICIA J (CNP)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:J
Last Name:EPHRAIM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:ALICE
Other - Middle Name:J
Other - Last Name:EPHRAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2413
Mailing Address - Country:US
Mailing Address - Phone:415-332-1553
Mailing Address - Fax:
Practice Address - Street 1:2238 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3416
Practice Address - Country:US
Practice Address - Phone:415-833-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner