Provider Demographics
NPI:1134378664
Name:EDDY, ALICIA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:EDDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:ANN
Other - Last Name:GRAFFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:FELTS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13638-0000
Mailing Address - Country:US
Mailing Address - Phone:315-767-1860
Mailing Address - Fax:
Practice Address - Street 1:30882 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:FELTS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13638-0000
Practice Address - Country:US
Practice Address - Phone:315-767-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1973291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse