Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 71001444A | IN |
NPI | 1003802067 |
---|---|
Provider Name | Nichole Hickman |
First Address | Bloomington, IN 47403-5001 |
Second Address | Bloomington, IN 47403-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 18/01/2021 |