Provider Demographics
NPI:1457439762
Name:POLICANI, ALYCIA R (ND)
Entity Type:Individual
Prefix:MRS
First Name:ALYCIA
Middle Name:R
Last Name:POLICANI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W BROADWAY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1819
Mailing Address - Country:US
Mailing Address - Phone:509-755-5100
Mailing Address - Fax:509-747-6646
Practice Address - Street 1:1801 W BROADWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1819
Practice Address - Country:US
Practice Address - Phone:509-755-5100
Practice Address - Fax:509-747-6646
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001028175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA912109085OtherFEIN