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General NPI Number Information
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NPI Number | 1700351830
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Entity Type | Individual
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Provider Name | CELESTE MARIE HICKEN NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 7050 S UNION PARK AVE STE 200
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City | MIDVALE
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State | UT
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Zip | 84047-4171
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Country | US
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Telephone | 888-562-5442
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Fax |
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Provider Business Mailing Address
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Address Line | 200 OCEANGATE # 1
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City | LONG BEACH
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State | CA
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Zip | 90802-4302
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Country | US
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Telephone | 888-562-5442
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Fax |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 6320538-3102
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6320538-4405
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License Number State | UT
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