MEDICARE: NIKKI BLACKMAN APN

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	363LF0000X	Family Nurse Practitioner	277002683	IL

General Provider Information

NPI Number	:	1801223987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI BLACKMAN APN

Provider Business Mailing Address
First Line	:	2981 KINGSTON DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6309
Country	:	US
Telephone Number	:	773-332-6310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2981 KINGSTON DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6309
Country	:	US
Telephone Number	:	773-332-6310
Fax Number	:

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

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	02/08/2024

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