| NPI | 1447032198 |
|---|---|
| Former Name | STEPHANIE LAUREN HICKLIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F311388-01) |
| Enumeration Date | 2023-10-17 |
| Last Update Date | 2023-10-17 |