MEDICARE: LAURA MARIE HICKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	914732	TX

General Provider Information

NPI Number	:	1194226696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE HICKMAN

Provider Business Mailing Address
First Line	:	1308 E 52ND ST UNIT A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3010
Country	:	US
Telephone Number	:	281-678-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 E 52ND ST UNIT A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3010
Country	:	US
Telephone Number	:	281-678-2340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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