Provider Demographics
NPI:1750571154
Name:SAPIENZA-WILSON, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:SAPIENZA-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NICKLIN LN
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1477
Mailing Address - Country:US
Mailing Address - Phone:610-558-9237
Mailing Address - Fax:
Practice Address - Street 1:3075 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1538
Practice Address - Country:US
Practice Address - Phone:610-265-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002390L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor