Provider Demographics
NPI:1265107023
Name:VATTER, ALICIA (FNP-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VATTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:SALISBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:750 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4423
Mailing Address - Country:US
Mailing Address - Phone:401-943-0761
Mailing Address - Fax:401-943-5737
Practice Address - Street 1:215 TOLL GATE RD STE 206A
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4461
Practice Address - Country:US
Practice Address - Phone:401-490-4515
Practice Address - Fax:401-490-4516
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily