Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1-157856 | AL |
NPI | 1548729890 |
---|---|
Provider Name | Lori Jolene Hicks-Glazner |
First Address | Warrior, AL 35180-4548 |
Second Address | Birmingham, AL 35233-1932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2019 |
Last Update Date | 12/11/2021 |