MEDICARE: LAUREN S. HICKS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1083601389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN S. HICKS PA

Provider Business Mailing Address
First Line	:	113 S IRVING ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1725
Country	:	US
Telephone Number	:	703-521-2627
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE
Second Line	:
City	:	BOLLING AFB
State	:	DC
Zip	:	20332-0001
Country	:	US
Telephone Number	:	202-767-5536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2005
Last Update Date	:	07/10/2007

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