# LAURA HICKENBOTTOM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1043617665
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LN0000X | Neonatal Nurse Practitioner | 2014040196 | MO | — |
| 363LN0000X | Neonatal Nurse Practitioner | 209014221 | IL | Yes |

## Other

- **Enumeration date:** 11/25/2014
- **Last updated:** 12/10/2021