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1972064913
GLENN HICKMAN
MODESTO, CA
NPI
1972064913
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CA 95011508)
Enumeration Date
2019-03-30
Last Update Date
2022-02-04
Business Address
GLENN HICKMAN NP
4601 DALE RD
MODESTO, CA 95356-9718
Phone number: 209-735-5000
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Mailing Address
GLENN HICKMAN NP
1333 MARISOL DR
MANTECA, CA 95337-8791
Phone number: 209-629-6535
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