Provider Demographics
NPI:1366942237
Name:BICKHAM, SIREANA ROCHELLE
Entity type:Individual
Prefix:
First Name:SIREANA
Middle Name:ROCHELLE
Last Name:BICKHAM
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 1:1900 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5053
Mailing Address - Country:US
Mailing Address - Phone:575-491-2988
Mailing Address - Fax:
Practice Address - Street 1:1900 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5053
Practice Address - Country:US
Practice Address - Phone:575-491-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator