Provider Demographics
NPI:1164049029
Name:NISSON HICKS, SUSAN JANE (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:NISSON HICKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JANE NISSON
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:900 ELKRIDGE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2924
Mailing Address - Country:US
Mailing Address - Phone:301-609-5350
Mailing Address - Fax:
Practice Address - Street 1:3145 MARSHALL HALL RD
Practice Address - Street 2:
Practice Address - City:BRYANS ROAD
Practice Address - State:MD
Practice Address - Zip Code:20616-4263
Practice Address - Country:US
Practice Address - Phone:301-609-5350
Practice Address - Fax:301-684-2134
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR091864363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily