Provider Demographics
NPI:1740495605
Name:HICKEY, CYNTHIA A (LPN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:HICKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 BELLFREY CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6370
Mailing Address - Country:US
Mailing Address - Phone:614-891-2861
Mailing Address - Fax:
Practice Address - Street 1:527 BELLFREY CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6370
Practice Address - Country:US
Practice Address - Phone:614-891-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN076805164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2514452Medicaid