Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | G03803 | MO |
NPI | 1417956897 |
---|---|
Provider Name | Dr. Dianna Lynn Hickman |
First Address | Kansas City, MO 64131-4517 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C03803 | (02) | MO |