Provider Demographics
NPI:1619099397
Name:ALICEA, MYRNA I (CRNP)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:I
Last Name:ALICEA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:I
Other - Last Name:ALICEA-MACALINDONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-7037
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 320
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-7818
Practice Address - Fax:215-752-0436
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025050510002Medicaid
PA9004062OtherCIGNA PA
PA7675993OtherAETNA
PAP01417918OtherRAILROAD MEDICARE
PASP009402OtherCRNP STATE LICENSE
PA30221870OtherKEYSTONE FIRST
PA3114453OtherHIGHMARK BLUE SHIELD
PARN526618LOtherREGISTERED NURSE LICENSE
PAP01417918OtherRAILROAD MEDICARE