Provider Demographics
NPI:1972398774
Name:HICKS, LEZLIE LOVETT (LVN)
Entity type:Individual
Prefix:
First Name:LEZLIE
Middle Name:LOVETT
Last Name:HICKS
Suffix:
Gender:
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 S INDIAN HILL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6003
Mailing Address - Country:US
Mailing Address - Phone:909-482-2066
Mailing Address - Fax:
Practice Address - Street 1:678 S INDIAN HILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6003
Practice Address - Country:US
Practice Address - Phone:909-482-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177517164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse