Individual
MARY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1 FORD PL, DETROIT, MI 48202
(800) 653-6568
Mailing address
28690 OLD NORTH RIVER RD, HARRISON TWP, MI 48045-1619
(586) 801-8488
(586) 228-4520
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704154971
MI
363LA2200X
Adult Health Nurse Practitioner
Primary
4704154971
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447241229
—
MI
Enumeration date
11/02/2005
Last updated
04/15/2025
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