Provider Demographics
NPI:1437156254
Name:SLAVEN-EMOND, ALICEMARIE F (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ALICEMARIE
Middle Name:F
Last Name:SLAVEN-EMOND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416
Mailing Address - Country:US
Mailing Address - Phone:970-964-7740
Mailing Address - Fax:970-874-6330
Practice Address - Street 1:1025 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-964-7740
Practice Address - Fax:970-874-6330
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0002573-C-NP363LF0000X
COC-APN.0994367-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59806028Medicaid
NMG1682Medicaid
CO268890ZS0NOtherMEDICARE B FOR NORTH FORK MEDICAL CLINIC
CO268890YUZGOtherMEDICARE B FOR DELTA HEALTH & WELLNESS CENTER
NMR26648OtherNM STATE RN LICENSURE #
CO59806028Medicaid