Provider Demographics
NPI:1992517015
Name:HICKS, SUSAN DEE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEE
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 1:3325 N 148TH CT APT 3206
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-7214
Mailing Address - Country:US
Mailing Address - Phone:520-977-3083
Mailing Address - Fax:
Practice Address - Street 1:3325 N 148TH CT APT 3206
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-7214
Practice Address - Country:US
Practice Address - Phone:520-977-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171M00000X
372600000X, 372500000X, 374U00000X, 376J00000X
NE05851132372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker