Healthcare Provider Details

I. General information

NPI: 1831182013
Provider Name (Legal Business Name): MARIE ANNE HICKEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE ANNE VIGUE MSN

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/03/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5778 DARROW RD SUITE D
HUDSON OH
44236-3808
US

IV. Provider business mailing address

PO BOX 8792
BELFAST ME
04915-8792
US

V. Phone/Fax

Practice location:
  • Phone: 330-655-2161
  • Fax: 330-650-2116
Mailing address:
  • Phone: 330-655-2161
  • Fax: 330-650-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN259927
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number03089-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: