Healthcare Provider Details

I. General information

NPI: 1164629473
Provider Name (Legal Business Name): DEBORAH S NICKOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HOSPITAL CIRCLE BLACKFEET COMMUNITY HOSPITAL
BROWNING MT
59417-0760
US

IV. Provider business mailing address

PO BOX 1769
BROWNING MT
59417-1769
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6369
  • Fax:
Mailing address:
  • Phone: 406-338-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN13135
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: