Provider Demographics
NPI:1568615474
Name:STOCKTON, ALICE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BLUE HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1151
Mailing Address - Country:US
Mailing Address - Phone:860-242-7834
Mailing Address - Fax:
Practice Address - Street 1:1551 BLUE HILLS AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1151
Practice Address - Country:US
Practice Address - Phone:860-242-7834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE36523163W00000X
CT000415363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse