| NPI | 1265040380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE DENISE HICKSON Family Nurse Practitioner 443-739-3814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2024-04-19 |