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NPI Code Detail

MEDICARE: ROSETTA M HICKS

MEDICARE: ROSETTA M HICKS
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
12355A2700XAudiology Assistant

General Provider Information

NPI Number : 1568793529
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSETTA M HICKS
Provider Business Mailing Address
First Line : 20402 N 15TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-3636
Country : US
Telephone Number : 623-445-4952
Fax Number : 623-445-5079
Provider Business Practice Location Address
First Line : 20402 N 15TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-3636
Country : US
Telephone Number : 623-445-4952
Fax Number : 623-445-5079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2010
Last Update Date : 01/14/2010

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Directions to “ ROSETTA M HICKS ” Practice Location

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