Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201702726NP-PP | OR |
NPI | 1033645213 |
---|---|
Provider Name | Natalia Ivanivna Hicks |
First Address | Ashland, OR 97520-1440 |
Second Address | Ashland, OR 97520-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2017 |
Last Update Date | 07/05/2017 |