Provider Demographics
NPI:1811265150
Name:HAEGELE, ALICIA ROSE (MSN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ROSE
Last Name:HAEGELE
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Gender:F
Credentials:MSN, CRNP
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Mailing Address - Street 1:MEDICAL ARTS BUILDING, 3801 MARKET STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3153
Mailing Address - Country:US
Mailing Address - Phone:215-662-9563
Mailing Address - Fax:215-243-4604
Practice Address - Street 1:MEDICAL ARTS BUILDING, 3801 MARKET STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3153
Practice Address - Country:US
Practice Address - Phone:215-662-9563
Practice Address - Fax:215-243-4604
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2020-11-06
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Provider Licenses
StateLicense IDTaxonomies
PASP010873363LA2200X
PASP014816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health