Provider Demographics
NPI:1295913994
Name:BICKHAM, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BICKHAM
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 1:4960 BACCICH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-6207
Mailing Address - Country:US
Mailing Address - Phone:504-544-4545
Mailing Address - Fax:985-645-8632
Practice Address - Street 1:4960 BACCICH ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-6207
Practice Address - Country:US
Practice Address - Phone:504-544-4545
Practice Address - Fax:985-645-8632
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2022-10-20
Deactivation Date:2022-10-02
Deactivation Code:
Reactivation Date:2022-10-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care