Provider Demographics
NPI:1427012111
Name:STROMQUIST, ALICIA BENNETT (PA-C, MMS)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:BENNETT
Last Name:STROMQUIST
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:WHITNEY
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:20 GLENLAKE PARKWAY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE MEDICAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:507-334-1601
Practice Address - Fax:507-334-3071
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10076363A00000X
GA005265363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN983181045999OtherPREFERRED ONE
MN0122818OtherMEDICA
MNHP59556OtherHEALTH PARTNERS
MN96G82BEOtherBCBS OF MN
MN138025C572OtherUCARE MN
MN430612100OtherMMSI
MN434830300Medicaid
MN410940705A029OtherTRICARE/WPS
MN983181045999OtherPREFERRED ONE
MNQ64100Medicare UPIN