Provider Demographics
NPI:1487690004
Name:HICE, LINDA L (CMF)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:HICE
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 S LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6708
Mailing Address - Country:US
Mailing Address - Phone:704-482-9938
Mailing Address - Fax:704-600-6433
Practice Address - Street 1:1100 S LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6708
Practice Address - Country:US
Practice Address - Phone:704-482-9938
Practice Address - Fax:704-600-6433
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFM00159229N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0186635OtherCIGNA
NC045JCOtherBLUE CROSS BLUE SHIELD
NC7703297Medicaid
NC045JCOtherBLUE CROSS BLUE SHIELD
NC7795304Medicaid