Healthcare Provider Details

I. General information

NPI: 1114306560
Provider Name (Legal Business Name): NORA HICKS RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 EAST SOUTH BLVD. SUITE 204
MONTGOMERY AL
36116-2460
US

IV. Provider business mailing address

2065 EAST SOUTH BLVD. SUITE 204
MONTGOMERY AL
36116-2460
US

V. Phone/Fax

Practice location:
  • Phone: 334-281-6990
  • Fax: 334-281-9725
Mailing address:
  • Phone: 334-281-6990
  • Fax: 334-281-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1088282
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: