Provider Demographics
NPI:1407312879
Name:HICKMAN, MAJA
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAJA
Other - Middle Name:
Other - Last Name:VUKAJLOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2251 WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-9269
Mailing Address - Country:US
Mailing Address - Phone:276-698-7224
Mailing Address - Fax:
Practice Address - Street 1:2251 WOODLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-9269
Practice Address - Country:US
Practice Address - Phone:276-698-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1095133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty