Healthcare Provider Details

I. General information

NPI: 1548729890
Provider Name (Legal Business Name): LORI JOLENE HICKS-GLAZNER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 11/12/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

230 FOX RIDGE DR
WARRIOR AL
35180-4548
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4311
  • Fax:
Mailing address:
  • Phone: 205-789-6699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1-157856
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1-157856
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: