Provider Demographics
NPI:1528518834
Name:HICKS, PATRICIA MARIE (CNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 S VINCENNES AVE
Mailing Address - Street 2:208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1459
Mailing Address - Country:US
Mailing Address - Phone:773-610-8821
Mailing Address - Fax:
Practice Address - Street 1:4724 S. VINCENNES
Practice Address - Street 2:208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:773-610-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL09712958376K00000X
IL0971376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide