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General NPI Number Information
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NPI Number | 1265040380
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Entity Type | Organization
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Legal Business Name | PATHWAY TO WELLNESS HEALTHCARE CENTER
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 1120 N CHARLES ST STE 400
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City | BALTIMORE
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State | MD
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Zip | 21201-5594
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Country | US
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Telephone | 443-739-3814
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Fax | 833-975-0904
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Provider Business Mailing Address
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Address Line | 1120 N CHARLES ST STE 400
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City | BALTIMORE
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State | MD
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Zip | 21201-5594
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Country | US
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Telephone | 443-739-3814
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Fax | 833-975-0904
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. NICOLE DENISE HICKSON
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Credential | CRNP
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Telephone | 443-739-3814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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