| Doctor Name: | MICHELLE COLEEN HICKS |
| NPI Number: | 1003232273 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | R175430-0 |
| Business Practice Address: | 4010 W 65th St Edina, MN - 554351706 |
| Business Phone Number: | 9524567000 |
| Business Fax Number: | 9524567001 |
| Mailing Address: | 4200 Dahlberg Dr, Suite 300 GOLDEN VALLEY |
| State: | MN |
| Postal Code: | 554224840 |
| Phone Number: | 9525125600 |
| Fax Number: | 9525125651 |
| NPI Enumeration Date: | 03/12/2014 |
| NPI Last Update Date: | 03/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R175430-0 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |