Provider Demographics
NPI:1336629526
Name:CEBULAK, ALICJA MONIKA (PMHNP)
Entity Type:Individual
Prefix:
First Name:ALICJA
Middle Name:MONIKA
Last Name:CEBULAK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 KUNDERT ST
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-4205
Mailing Address - Country:US
Mailing Address - Phone:701-448-9225
Mailing Address - Fax:
Practice Address - Street 1:416 KUNDERT ST
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-4205
Practice Address - Country:US
Practice Address - Phone:701-448-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty