Provider Demographics
NPI:1487040820
Name:HICKEY, LISA MARIE (LVNB)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:LVNB
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1330 N INDIAN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4880
Mailing Address - Country:US
Mailing Address - Phone:760-322-9065
Mailing Address - Fax:
Practice Address - Street 1:1330 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-322-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN235264164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse