MEDICARE: SHIRLEY HICKMAN

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1669530689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY HICKMAN

Provider Business Mailing Address
First Line	:	8185 SPARLING RD
Second Line	:
City	:	WALES
State	:	MI
Zip	:	48027-2007
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 GRATIOT BLVD
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-1145
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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Directions to “ SHIRLEY HICKMAN ” Practice Location

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