Provider Demographics
NPI:1649680695
Name:HICKSON, ERICA (ARNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HICKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:FRIGONE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 741515
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-1515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1344 WINTERGREEN LN NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-5147
Practice Address - Country:US
Practice Address - Phone:206-842-5632
Practice Address - Fax:206-842-5992
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60471978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649680695Medicaid
WAG8939805, G8939806Medicare PIN