Provider Demographics
NPI:1538649066
Name:HICKS, ELIZABETH ANNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNETTE
Last Name:HICKS
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 1:4729 KRATZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22802-1216
Mailing Address - Country:US
Mailing Address - Phone:540-578-5806
Mailing Address - Fax:
Practice Address - Street 1:30 BAXTER DR STE 180
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7632
Practice Address - Country:US
Practice Address - Phone:540-908-3917
Practice Address - Fax:540-438-5783
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002047576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse