Provider Demographics
NPI:1700149622
Name:ALICEA, MADELINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 WHITE PLAINS ROAD
Mailing Address - Street 2:BLDG #3 APT 14X
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:914-332-1872
Mailing Address - Fax:
Practice Address - Street 1:29 SOUTH HIGHLAND AVE
Practice Address - Street 2:OSSINING HIGH SCHOOL
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562
Practice Address - Country:US
Practice Address - Phone:914-762-5760
Practice Address - Fax:914-941-2093
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273218-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse