Provider Demographics
NPI:1811168123
Name:JOHN, ALICIA A (CNS, BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:A
Last Name:JOHN
Suffix:
Gender:F
Credentials:CNS, BSN, RN
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:HANAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS, BSN, RN
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 178585-8364SA2200X
TX717432364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX882N39OtherBCBS
TX302868001Medicaid
TX302868001Medicaid