Basic Information
Provider Information
NPI: 1639645625
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BICKERT
FirstName: BRITT
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5310 KIETZKE LN STE 104
Address2:  
City: RENO
State: NV
PostalCode: 895112043
CountryCode: US
TelephoneNumber: 1775348880
FaxNumber:  
Practice Location
Address1: 9990 DOUBLE R BLVD STE 200
Address2:  
City: RENO
State: NV
PostalCode: 895214833
CountryCode: US
TelephoneNumber: 7753488800
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/17/2018
LastUpdateDate: 10/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA2033NVY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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