Healthcare Provider Details

I. General information

NPI: 1831548452
Provider Name (Legal Business Name): ANGELA HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 06/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 GILBERT AVE
CINCINNATI OH
45206-1021
US

IV. Provider business mailing address

3002 GILBERT AVE
CINCINNATI OH
45206-1021
US

V. Phone/Fax

Practice location:
  • Phone: 513-655-0046
  • Fax:
Mailing address:
  • Phone: 513-655-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number346461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: