Provider Demographics
NPI:1114413390
Name:HICKS, DEVINA CORA
Entity Type:Individual
Prefix:
First Name:DEVINA
Middle Name:CORA
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FLAMINGO LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1410
Mailing Address - Country:US
Mailing Address - Phone:845-638-0402
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2532
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:845-624-0264
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294658-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse