Healthcare Provider Details

I. General information

NPI: 1922659671
Provider Name (Legal Business Name): MARY HICKMAN MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 950
HONOLULU HI
96814-1874
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 950
HONOLULU HI
96814-1874
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-7555
  • Fax: 847-723-8675
Mailing address:
  • Phone: 808-373-7555
  • Fax: 808-373-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: