Provider Demographics
NPI:1922417781
Name:ORTIZ, ALISIA JOANN (WHNP-BC, MSN)
Entity Type:Individual
Prefix:
First Name:ALISIA
Middle Name:JOANN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:WHNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 KEOTA ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7664
Mailing Address - Country:US
Mailing Address - Phone:325-212-1741
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-9656
Practice Address - Fax:719-333-5251
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1621751163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory