Provider Demographics
NPI:1659535185
Name:WETHERHULT, ALICIA LYNN (CNA)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:LYNN
Last Name:WETHERHULT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MARGARET ST
Mailing Address - Street 2:SUITE 2-6
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1689
Mailing Address - Country:US
Mailing Address - Phone:518-563-2106
Mailing Address - Fax:
Practice Address - Street 1:256 MARGARET ST
Practice Address - Street 2:SUITE 2-6
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1689
Practice Address - Country:US
Practice Address - Phone:518-563-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide