Provider Demographics
NPI:1518566819
Name:PETRI, ALICIA NICOLE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:PETRI
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:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:CRIPPLE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80813-1224
Mailing Address - Country:US
Mailing Address - Phone:719-493-7027
Mailing Address - Fax:
Practice Address - Street 1:218 N 2ND STREET
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813-8081
Practice Address - Country:US
Practice Address - Phone:719-493-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty