Healthcare Provider Details

I. General information

NPI: 1003802067
Provider Name (Legal Business Name): NICHOLE HICKMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LANDMARK AVE
BLOOMINGTON IN
47403-5001
US

IV. Provider business mailing address

350 S LANDMARK AVE
BLOOMINGTON IN
47403-5001
US

V. Phone/Fax

Practice location:
  • Phone: 812-335-2434
  • Fax: 812-335-7604
Mailing address:
  • Phone: 812-335-2434
  • Fax: 812-335-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71001444A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: