Individual
LAURA HICKENBOTTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
611 W. PARK ST., NEONATOLOGY, URBANA, IL 61801-2500
(217) 383-3266
(217) 383-3463
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6941
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
2014040196
MO
363LN0000X
Neonatal Nurse Practitioner
Primary
209014221
IL
Other
Enumeration date
11/25/2014
Last updated
12/10/2021
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