Provider Demographics
NPI:1003948001
Name:HICKOK, ANNA MARIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:HICKOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 TEXAS RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-6056
Mailing Address - Country:US
Mailing Address - Phone:315-493-0558
Mailing Address - Fax:
Practice Address - Street 1:258 CHAMPION ST
Practice Address - Street 2:BUILDING 500
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-3361
Practice Address - Country:US
Practice Address - Phone:315-408-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277484-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse