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General NPI Number Information
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NPI Number | 1669459301
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Entity Type | Individual
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Provider Name | STEVEN EUGENE NICKMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | LOGAN CANCER CENTER 1281 NORTH 600 EAST
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City | LOGAN
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State | UT
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Zip | 84341
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Country | US
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Telephone | 435-716-6400
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Fax | 385-297-2348
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Provider Business Mailing Address
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Address Line | LOGAN CANCER CENTER 1281 NORTH 600 EAST
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City | LOGAN
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State | UT
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Zip | 84341
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Country | US
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Telephone | 435-716-6400
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Fax | 385-297-2348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 276391-1206
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License Number State | UT
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