Provider Demographics
NPI:1225232077
Name:HICKS, CARA LOU (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:LOU
Last Name:HICKS
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 1:28690 STATE ROUTE 159
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9780
Mailing Address - Country:US
Mailing Address - Phone:740-477-8728
Mailing Address - Fax:
Practice Address - Street 1:28690 STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9780
Practice Address - Country:US
Practice Address - Phone:740-477-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 102912164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2708243OtherINDEPENDANT PROVIDER