Basic Information
| Provider Information | |||||||||
| NPI: | 1659887388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HICKS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10530 TOWNSHIP ROAD 49 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PERRY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437609729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405047052 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2951 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404545000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2017 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | LE-00022023 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.