Provider Demographics
NPI:1538580568
Name:HICKS, TOLEDA LENOR
Entity type:Individual
Prefix:
First Name:TOLEDA
Middle Name:LENOR
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2429
Mailing Address - Country:US
Mailing Address - Phone:702-807-1855
Mailing Address - Fax:
Practice Address - Street 1:1109 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2429
Practice Address - Country:US
Practice Address - Phone:702-807-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker