Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | R196128 | MD |
NPI | 1174021927 |
---|---|
Provider Name | Crystal Marie Hicks |
First Address | Edgewater, MD 21037-3520 |
Second Address | Baltimore, MD 21237-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 26/01/2018 |