Provider Demographics
NPI:1033206545
Name:HICKS, WANDA DENISE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:DENISE
Last Name:HICKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 E I65 SERVICE RD S STE 106
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3101
Mailing Address - Country:US
Mailing Address - Phone:251-408-7568
Mailing Address - Fax:251-272-3098
Practice Address - Street 1:601 VALLIER CT
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572-2832
Practice Address - Country:US
Practice Address - Phone:251-408-7568
Practice Address - Fax:251-272-3098
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1090842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily