Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A89215 | CA |
Y | 208000000X | Pediatrician | BC60332422 | WA |
NPI | 1003962655 |
---|---|
Provider Name | Elizabeth Amy Hicks |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 04/02/2013 |