Provider Demographics
NPI:1649438276
Name:SIERRA, ALICE CHRISTINA (RN)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:CHRISTINA
Last Name:SIERRA
Suffix:
Gender:F
Credentials:RN
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 1201
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1201
Mailing Address - Country:US
Mailing Address - Phone:605-867-3286
Mailing Address - Fax:605-867-3097
Practice Address - Street 1:E HWY 18
Practice Address - Street 2:PINE RIDGE HOSPITAL
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-3286
Practice Address - Fax:605-867-3097
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDRO17951163W00000X, 163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDRO17951OtherBOARD OF NURSING