Healthcare Provider Details

I. General information

NPI: 1861447229
Provider Name (Legal Business Name): CAROL HICKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 HIGH ST
PORTSMOUTH NH
03801-3708
US

IV. Provider business mailing address

469 LINCOLN AVE
PORTSMOUTH NH
03801-5058
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-6803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0218482304
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: