1609871003 NPI number — MS. LYNN HICKOX NP;CNM

Table of content: MS. LYNN HICKOX NP;CNM (NPI 1609871003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609871003 NPI number — MS. LYNN HICKOX NP;CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKOX
Provider First Name:
LYNN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP;CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609871003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
824 FRANKLIN PK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-432-1048
Provider Business Mailing Address Fax Number:
315-432-9219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
824 FRANKLIN PK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-432-1048
Provider Business Practice Location Address Fax Number:
315-432-9219
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  F000673 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01763193 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000013877 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161529574 . This is a "TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000916155001 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426015267 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1899983 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5626602 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com