Provider Demographics
NPI:1841208550
Name:HICKS, LUANNE F (NP)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:F
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W HAMPDEN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2165
Mailing Address - Country:US
Mailing Address - Phone:303-341-4730
Mailing Address - Fax:
Practice Address - Street 1:750 W HAMPDEN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2165
Practice Address - Country:US
Practice Address - Phone:303-341-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO63512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83121242Medicaid