Individual
JASON HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
500 S MAPLE ST, WACONIA, MN 55387-1752
(952) 442-2191
Mailing address
PO BOX 81, CHASKA, MN 55318-0081
(888) 398-3327
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9243
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36D52HI
BCBS
—
01
—
HP36290
HEALTH PARTNERS
—
Enumeration date
06/06/2006
Last updated
12/04/2007
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