Alicia Anne Mamienski, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

SP013806 Issued in PA

Practice address

3400 Civic Center Blvd
Philadelphia, PA 19104-5127

Phone

(267) 425-4650

NPI assigned

Aug 1, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406851200000",
    "number": "1962810069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 GOLF HILLS RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190831034",
            "telephone_number": "347-804-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "267-425-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMIENSKI",
        "first_name": "ALICIA",
        "middle_name": "ANNE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-01",
        "last_updated": "2014-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "SP013806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malvern Constitution LLC (Malvern Behavioral Health)
• Priya Mamachan, DMD
• Algird R Mameniskis, M.D., F.A.C.S.
• Mamesee Home Health Care LLC
• Sanjana Reddy Mamidi, DDS
• Ajit Mammen, M.B.B.S.
• Evelyn Mammen
• Mirium Mammen, DO
• Priya Elizabeth Mammen, MD
• Christopher James Mammola, PTA

• Pediatric Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.