Provider Demographics
NPI:1528344165
Name:HICKERSON, KIRSTEN (RN)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041
Mailing Address - Country:US
Mailing Address - Phone:610-896-1089
Mailing Address - Fax:215-230-7599
Practice Address - Street 1:370 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1336
Practice Address - Country:US
Practice Address - Phone:610-896-1089
Practice Address - Fax:215-230-7599
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN321512L163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1255626529OtherLINKED WITH HAVERFORD COLLEGE GRP NPI