Provider Demographics
NPI:1689447591
Name:SUAREZ-HICKEY, CONNIE R (PMHNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:R
Last Name:SUAREZ-HICKEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 147 DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-9673
Mailing Address - Country:US
Mailing Address - Phone:406-207-0413
Mailing Address - Fax:
Practice Address - Street 1:2279 147 DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-9673
Practice Address - Country:US
Practice Address - Phone:406-207-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2023124921363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health