Provider Demographics
NPI:1861922619
Name:STIDHAM, ALICIA K
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:K
Last Name:STIDHAM
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 1:964 DUBOIS RD APT G
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-3734
Mailing Address - Country:US
Mailing Address - Phone:513-267-2992
Mailing Address - Fax:
Practice Address - Street 1:964 DUBOIS RD APT G
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-3734
Practice Address - Country:US
Practice Address - Phone:513-267-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide