Provider Demographics
NPI:1629363759
Name:HICKEY, MAUREEN JANE
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:JANE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W BRUNDAGE ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-674-4205
Mailing Address - Fax:307-674-1667
Practice Address - Street 1:151 W BRUNDAGE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4217
Practice Address - Country:US
Practice Address - Phone:307-674-4205
Practice Address - Fax:307-674-1667
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator