Provider Demographics
NPI:1598206542
Name:HICKS, DELISHA LASHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:DELISHA
Middle Name:LASHA
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 1:384 MOORISH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8412
Mailing Address - Country:US
Mailing Address - Phone:567-277-2056
Mailing Address - Fax:
Practice Address - Street 1:384 MOORISH AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8412
Practice Address - Country:US
Practice Address - Phone:567-277-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159999164W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse