Individual
SHAUNA HICKEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
201 N GARTH AVE, COLUMBIA, MO 65203-4105
(573) 449-3953
Mailing address
201 N GARTH AVE, COLUMBIA, MO 65203-4105
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
2013019513
MO
Other
Enumeration date
07/31/2013
Last updated
11/05/2013
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