Provider Demographics
NPI:1689723801
Name:KING, PRINCESS ALICE (MA,CNA)
Entity Type:Individual
Prefix:MS
First Name:PRINCESS
Middle Name:ALICE
Last Name:KING
Suffix:
Gender:F
Credentials:MA,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 KEEN CT
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8482
Mailing Address - Country:US
Mailing Address - Phone:910-904-0894
Mailing Address - Fax:910-904-0894
Practice Address - Street 1:2209 KEEN CT
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8482
Practice Address - Country:US
Practice Address - Phone:910-904-0894
Practice Address - Fax:910-904-0894
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide