Provider Demographics
NPI:1750262010
Name:CULVER, ALICIA L
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:CULVER
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 1:12537 W CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-8034
Mailing Address - Country:US
Mailing Address - Phone:608-346-8784
Mailing Address - Fax:
Practice Address - Street 1:12537 W CARROLL RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-8034
Practice Address - Country:US
Practice Address - Phone:608-346-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIC416-0128-6841-09172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver