Healthcare Provider Details

I. General information

NPI: 1295216232
Provider Name (Legal Business Name): RYAN THOMAS HICKMAN AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD STE 210
WILMINGTON DE
19808-5400
US

IV. Provider business mailing address

115 CHRISTINA LANDING DR APT 406
WILMINGTON DE
19801-5455
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberO2-0000238
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: