Individual
MS. DEBRA ANN HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
500 COMMACK RD, COMMACK, NY 11725-5020
(631) 638-0150
(631) 638-0157
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 638-0150
(631) 638-0157
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F380777-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00401381
—
NY
01
—
112245457
RBK TAX ID#
NY
Enumeration date
03/15/2007
Last updated
05/01/2017
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