Provider Demographics
NPI:1629387345
Name:ATKINS, ALICIA JERI (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:JERI
Last Name:ATKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:JERI
Other - Last Name:CLAESSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2325
Mailing Address - Country:US
Mailing Address - Phone:218-741-3340
Mailing Address - Fax:218-749-9427
Practice Address - Street 1:901 9TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2325
Practice Address - Country:US
Practice Address - Phone:218-741-3340
Practice Address - Fax:218-749-9427
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN193945-5367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered