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Individual

JOSEPH P HICKEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP-BC

Contact information

Practice address
5820 S. EASTERN, LIFESTYLE CENTER, LAS VEGAS, NV 89119
(702) 797-2353
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 579-3298

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
APRN001803
NV
363LF0000X
Family Nurse Practitioner
209-005046
IL
363LF0000X
Family Nurse Practitioner
2167-033
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1942386776
NV
01
V108918
SMACC MEDICARE
NV
Enumeration date
10/27/2006
Last updated
12/10/2014
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