Provider Demographics
NPI:1952622748
Name:BOSTIC, ALICIA JAVONNA
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:JAVONNA
Last Name:BOSTIC
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 1:1 SAILS WAY DR
Mailing Address - Street 2:APT E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-7034
Mailing Address - Country:US
Mailing Address - Phone:336-641-6583
Mailing Address - Fax:
Practice Address - Street 1:1 SAILS WAY DR
Practice Address - Street 2:APT G
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-7034
Practice Address - Country:US
Practice Address - Phone:336-641-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC263903376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide