Provider Demographics
NPI:1205445400
Name:BASHAM, ALESIA MARIE
Entity type:Individual
Prefix:
First Name:ALESIA
Middle Name:MARIE
Last Name:BASHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:WV
Mailing Address - Zip Code:25878-0527
Mailing Address - Country:US
Mailing Address - Phone:304-890-9940
Mailing Address - Fax:
Practice Address - Street 1:216 BLUE ROOM RD
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921
Practice Address - Country:US
Practice Address - Phone:304-890-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant