Healthcare Provider Details

I. General information

NPI: 1851394092
Provider Name (Legal Business Name): TWILA J FICKEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 CHADRON AVE
CHADRON NE
69337-2347
US

IV. Provider business mailing address

221 CHADRON AVE
CHADRON NE
69337-2347
US

V. Phone/Fax

Practice location:
  • Phone: 308-432-2407
  • Fax: 308-432-8480
Mailing address:
  • Phone: 308-432-2407
  • Fax: 308-432-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number212
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: