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General NPI Number Information
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NPI Number | 1013382571
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Entity Type | Organization
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Legal Business Name | KEVIN HICKMAN CRNA NURSING INC
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 8816 BURTON WAY
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1715
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Country | US
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Telephone | 310-285-9612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7001
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City | TARZANA
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State | CA
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Zip | 91357-7001
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Country | US
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Telephone | 818-888-7815
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Fax | 818-715-1722
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Authorized Official
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Title or Position | SOLE OWNER
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Name | KEVIN HICKMAN
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Credential | CRNA
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Telephone | 315-706-5669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4391
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License Number State | CA
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