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Individual

MICHELLE L HICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
600 N ROBBINS RD, SUITE 100, BOISE, ID 83702-4566
(208) 383-0201
(208) 489-4300
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
6541979-4405
UT
363LA2200X
Adult Health Nurse Practitioner
Primary
NP-641A
ID

Other

Enumeration date
08/23/2006
Last updated
04/04/2011
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