Individual
DR. JENNIFER ANN HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 W. PARK ST., URBANA, IL 61801-2500
(217) 383-3303
(217) 383-3265
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
48920020
WI
207LP3000X
Pediatric Anesthesiology Physician
Primary
036138744
IL
207LP3000X
Pediatric Anesthesiology Physician
48920
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043399967
—
WI
Enumeration date
11/02/2006
Last updated
10/02/2015
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