Individual
LISA E HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
123 EMMA RD STE 106, BASALT, CO 81621-9169
(970) 945-2840
Mailing address
PO BOX 339, GLENWOOD SPRINGS, CO 81602-0339
(970) 331-4363
(970) 945-2893
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/29/2024
Last updated
08/05/2024
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