Provider Demographics
NPI:1972690261
Name:HICKEY, LETA HOUSTON (RN, CNP)
Entity type:Individual
Prefix:
First Name:LETA
Middle Name:HOUSTON
Last Name:HICKEY
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40555 BURTON TRL
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-6692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40555 BURTON TRL
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-6692
Practice Address - Country:US
Practice Address - Phone:440-423-0437
Practice Address - Fax:440-423-0461
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-198048163WN0002X
OHCTP-02010363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Not Answered363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal