Individual
LISA A HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17177 N LAUREL PARK DR STE 417, LIVONIA, MI 48152-3952
(888) 414-7056
Mailing address
23576 CLINTON ST, TAYLOR, MI 48180-4157
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703120442
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
O435522029817
—
MI
Enumeration date
01/07/2020
Last updated
01/07/2020
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