Individual
MARY KAY BICKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-6000
Mailing address
3100 SPRING FOREST RD, SUITE 130, RALEIGH, NC 27616-2880
(919) 882-0705
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024170746
VA
367500000X
Certified Registered Nurse Anesthetist
4704153665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366418394
—
VA
05
—
3284918
—
MI
01
—
430F373940
BCBSM
MI
Enumeration date
02/28/2006
Last updated
12/05/2013
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