Healthcare Provider Details

I. General information

NPI: 1669459301
Provider Name (Legal Business Name): STEVEN EUGENE NICKMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 08/13/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOGAN CANCER CENTER 1281 NORTH 600 EAST
LOGAN UT
84341
US

IV. Provider business mailing address

LOGAN CANCER CENTER 1281 NORTH 600 EAST
LOGAN UT
84341
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-6400
  • Fax: 385-297-2348
Mailing address:
  • Phone: 435-716-6400
  • Fax: 385-297-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number276391-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: