Provider Demographics
NPI:1184933764
Name:HICKS, ISAAC L III (RD, LDN)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:L
Last Name:HICKS
Suffix:III
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4406
Mailing Address - Country:US
Mailing Address - Phone:302-423-9035
Mailing Address - Fax:
Practice Address - Street 1:713 E. BASIN ROAD E-123
Practice Address - Street 2:WILLIAM PENN HS WELLNESS CENTER
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720
Practice Address - Country:US
Practice Address - Phone:302-423-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered