MEDICARE: MR. STEVEN EUGENE NICKMAN PA-C

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
1	363AM0700X	Medical Physician Assistant	276391-1206	UT

General Provider Information

NPI Number	:	1669459301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN EUGENE NICKMAN PA-C

Provider Business Mailing Address
First Line	:	LOGAN CANCER CENTER
Second Line	:	1281 NORTH 600 EAST
City	:	LOGAN
State	:	UT
Zip	:	84341
Country	:	US
Telephone Number	:	435-716-6400
Fax Number	:	385-297-2348

Provider Business Practice Location Address
First Line	:	LOGAN CANCER CENTER
Second Line	:	1281 NORTH 600 EAST
City	:	LOGAN
State	:	UT
Zip	:	84341
Country	:	US
Telephone Number	:	435-716-6400
Fax Number	:	385-297-2348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	08/13/2025

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