Most Relevant Information
Provider Data
| NPI Number: | 1003802067 |
| Provider Name: | NICHOLE HICKMAN NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0200X |
| Specialty: | Nurse Practitioner |
| License Number: | 71001444A |
Most Important Dates
| Enumeration Date: | 09/26/2005 |
| Last Updated: | 01/18/2021 |
Provider Practice Location
350 S LANDMARK AVE
BLOOMINGTON
IN
474035001
Practice Location Phone/Fax
| Phone: | 8123352434 |
| Fax: | 8123357604 |
Provider Mailing Location
350 S LANDMARK AVE
BLOOMINGTON
IN
474035001
Provider Mailing Phone/Fax
| Phone: | 8123352434 |
| Fax: | 8123357604 |