MEDICARE: LORRAINE D HICKS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	SP021532	PA

General Provider Information

NPI Number	:	1356966717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE D HICKS NP

Provider Business Mailing Address
First Line	:	1144 E STAFFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3478 LAKESIDE DR NE UNIT 1004
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1859
Country	:	US
Telephone Number	:	404-662-8902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	02/04/2026

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