Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP016282 | PA |
NPI | 1316493687 |
---|---|
Provider Name | Wilson Hickman |
First Address | Washington, PA 15301 |
Second Address | Washington, PA 15301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2016 |
Last Update Date | 28/08/2016 |