Provider Demographics
NPI:1356999197
Name:HICKS, JULIANE BOOKER
Entity type:Individual
Prefix:
First Name:JULIANE
Middle Name:BOOKER
Last Name:HICKS
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 1:10211 BOOKERS LN
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-3121
Mailing Address - Country:US
Mailing Address - Phone:804-904-7976
Mailing Address - Fax:
Practice Address - Street 1:10211 BOOKERS LN
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-3121
Practice Address - Country:US
Practice Address - Phone:804-904-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2679372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion