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NPI Code Detail

MEDICARE: EUGENE HICKEY CRNA

MEDICARE: EUGENE HICKEY CRNA
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
1367500000XCertified Registered Nurse AnesthetistIL

General Provider Information

NPI Number : 1215989777
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUGENE HICKEY CRNA
Provider Business Mailing Address
First Line : 255 W MICHIGAN AVE
Second Line :
City : JACKSON
State : MI
Zip : 49201-2218
Country : US
Telephone Number : 800-242-1131
Fax Number : 517-787-4146
Provider Business Practice Location Address
First Line : 150 W HIGH ST
Second Line :
City : MORRIS
State : IL
Zip : 60450-1463
Country : US
Telephone Number : 630-472-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 07/08/2007

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Directions to “ EUGENE HICKEY CRNA” Practice Location

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