Provider Demographics
NPI:1629615448
Name:GILBERT, ALICE (RN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:RADCLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:635 SHANNON CORNERS RD # A
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:NY
Mailing Address - Zip Code:14837-9158
Mailing Address - Country:US
Mailing Address - Phone:667-201-6878
Mailing Address - Fax:
Practice Address - Street 1:635 SHANNON CORNERS RD # A
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:NY
Practice Address - Zip Code:14837-9158
Practice Address - Country:US
Practice Address - Phone:667-201-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771877163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health