Provider Demographics
NPI:1699584235
Name:HICKS, DANIELLE RAE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAE
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 1:111 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4628
Mailing Address - Country:US
Mailing Address - Phone:701-822-0218
Mailing Address - Fax:
Practice Address - Street 1:620 BAVARIA DR
Practice Address - Street 2:MINOT
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703
Practice Address - Country:US
Practice Address - Phone:701-822-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health