Provider Demographics
NPI:1578933677
Name:HICKS-REED, ALEXIS AMINITA (LPN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:AMINITA
Last Name:HICKS-REED
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 1:28054 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2843
Mailing Address - Country:US
Mailing Address - Phone:313-844-9849
Mailing Address - Fax:
Practice Address - Street 1:20724 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5313
Practice Address - Country:US
Practice Address - Phone:734-324-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703108844164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse