Provider Demographics
NPI:1659838464
Name:HICKEY, CHRISTINE A (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:HICKEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 OLD BLACK HORSE PIKE APT Z10
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4921
Mailing Address - Country:US
Mailing Address - Phone:765-760-5336
Mailing Address - Fax:
Practice Address - Street 1:415 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8135
Practice Address - Country:US
Practice Address - Phone:856-696-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22115800163W00000X
NJ26NJ01078700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300025601Medicaid