Provider Demographics
NPI:1811392350
Name:HICKMAN, ROBYN LYNN (MA-P)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:LYNN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MA-P
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:LYNN
Other - Last Name:MEHRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-P
Mailing Address - Street 1:14633 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4257
Mailing Address - Country:US
Mailing Address - Phone:530-227-9810
Mailing Address - Fax:
Practice Address - Street 1:14633 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4257
Practice Address - Country:US
Practice Address - Phone:530-227-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT00013566291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory