Individual
GLENDA D HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 AIRPORT WAY, FAIRBANKS, AK 99701-6039
(907) 456-8901
(907) 452-5171
Mailing address
805 AIRPORT WAY, FAIRBANKS, AK 99701-6039
(907) 456-8901
(907) 452-5171
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
171MOOOOOX
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM3835
CARE COORDINATOR NUMBER
AK
Enumeration date
04/20/2007
Last updated
07/08/2007
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