Provider Demographics
NPI:1396382313
Name:HICKMAN, RUTH ELLEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 LEMONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2128
Mailing Address - Country:US
Mailing Address - Phone:707-494-5399
Mailing Address - Fax:
Practice Address - Street 1:7043 LEMONWOOD LN
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2128
Practice Address - Country:US
Practice Address - Phone:707-494-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7055F363LG0600X
CA501231163W00000X
CA7055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse