Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH00002107 | WA |
NPI | 1629187216 |
---|---|
Provider Name | Dr. Patrick J. Hickman |
First Address | Moses Lake, WA 98837-1796 |
Second Address | Moses Lake, WA 98837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |