Provider Demographics
NPI:1730898974
Name:TURNER, ELICIA DAWN
Entity type:Individual
Prefix:MRS
First Name:ELICIA
Middle Name:DAWN
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELICIA
Other - Middle Name:DAWN
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1066 W WINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6326
Mailing Address - Country:US
Mailing Address - Phone:907-521-7073
Mailing Address - Fax:
Practice Address - Street 1:1363 W SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-5327
Practice Address - Country:US
Practice Address - Phone:907-521-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7093182OtherDRIVER'S LISCENSE