Individual
DR. CHARLENE J HICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1218 S PUEBLO BLVD, PUEBLO, CO 81005-1593
(719) 566-1277
(719) 566-1257
Mailing address
1218 S PUEBLO BLVD, PUEBLO, CO 81005-1593
(719) 566-1277
(719) 566-1257
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
39435
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50255843
—
CO
Enumeration date
05/16/2006
Last updated
09/08/2022
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