Provider Demographics
NPI:1033645213
Name:HICKS, NATALIA IVANIVNA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:IVANIVNA
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:IVANIVNA
Other - Last Name:OLENDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3074 BAILEY LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6927
Mailing Address - Country:US
Mailing Address - Phone:541-913-9909
Mailing Address - Fax:
Practice Address - Street 1:3074 BAILEY LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6927
Practice Address - Country:US
Practice Address - Phone:541-913-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-07
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201390298RN163W00000X
OR201702726NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse