# STEPHEN A. HICKNER, M.D., LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003115577
- **Authorized official:** STEPHEN ANDREW HICKNER M.D. (REGISTERED AGENT)
- **Authorized official phone:** (616) 633-8628

## Contact information

- **Practice address:** 8160 HIGHWAY 789, LANDER, WY 82520-2953
- **Practice address phone:** (616) 633-8628
- **Mailing address:** 8160 HIGHWAY 789, LANDER, WY 82520-2953
- **Mailing address phone:** (616) 633-8628

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | TL1524 | WY | Yes |

## Other

- **Enumeration date:** 03/22/2011
- **Last updated:** 03/29/2011