Provider Demographics
NPI:1275998775
Name:HICKMAN, JASMIN (LPN)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:HICKMAN
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 1:2822 UPTON AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3959
Mailing Address - Country:US
Mailing Address - Phone:567-277-6518
Mailing Address - Fax:
Practice Address - Street 1:2822 UPTON AVE UPPR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3959
Practice Address - Country:US
Practice Address - Phone:567-277-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160479-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse