| Doctor Name: | MRS. TANDA ELIZABETH HICKS |
| NPI Number: | 1053312504 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 18710-0263 |
| Business Practice Address: | 1551 Brice St Wheatland Medical Clinic Wheatland, WY - 822013505 |
| Business Phone Number: | 3073223861 |
| Business Fax Number: | 3073222018 |
| Mailing Address: | 1551 Brice St, WHEATLAND |
| State: | WY |
| Postal Code: | 822013505 |
| Phone Number: | 3073223861 |
| Fax Number: | 3073222018 |
| NPI Enumeration Date: | 08/09/2005 |
| NPI Last Update Date: | 12/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 18710-0263 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |