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NPI Code Detail

MEDICARE: SANDRA LEE HICKMAN RNBSN

MEDICARE: SANDRA LEE HICKMAN RNBSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse73318CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033405675
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA LEE HICKMAN RNBSN
Provider Business Mailing Address
First Line : 101 W 9TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-4103
Country : US
Telephone Number : 719-583-4308
Fax Number : 719-583-4375
Provider Business Practice Location Address
First Line : 101 W 9TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-4103
Country : US
Telephone Number : 719-583-4308
Fax Number : 719-583-4375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2011
Last Update Date : 06/22/2011

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Directions to “ SANDRA LEE HICKMAN RNBSN” Practice Location

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