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General NPI Number Information
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NPI Number | 1962987511
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Entity Type | Individual
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Provider Name | LYNETTA TRICE-BICKHAM APRN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2018
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Last Update Date | 03/24/2024
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Provider Practice Location Address
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Address Line | 400 N HIGHLAND AVE
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City | AURORA
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State | IL
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Zip | 60506-3814
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Country | US
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Telephone | -123-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 ESSINGTON RD SUITE B #64
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City | JOLIET
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State | IL
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Zip | 60435-1204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209018295
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License Number State | IL
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