Provider Demographics
NPI:1497993059
Name:WERK, ALICIA MYRICK (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MYRICK
Last Name:WERK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 67
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9705
Mailing Address - Country:US
Mailing Address - Phone:406-673-3777
Mailing Address - Fax:406-673-3144
Practice Address - Street 1:123 WHITE COW CANYON ROAD
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:MT
Practice Address - Zip Code:59527-0000
Practice Address - Country:US
Practice Address - Phone:406-673-3777
Practice Address - Fax:406-673-3144
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT36292163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse