Provider Demographics
NPI:1689904088
Name:STASHER, ALICIA Y (LPN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:Y
Last Name:STASHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SAN RAFAEL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2413
Mailing Address - Country:US
Mailing Address - Phone:419-531-2077
Mailing Address - Fax:
Practice Address - Street 1:55 SAN RAFAEL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OHIO
Practice Address - Zip Code:43607
Practice Address - Country:UM
Practice Address - Phone:419-531-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130189M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse