Individual
LESLIE ANN HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
405 RUSHING DR, HERRIN, IL 62948-3730
(618) 993-3300
(618) 993-0262
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.018346
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.018346
ILLINOIS ADVANCE PRACTICE NURSE LICENSE
IL
Enumeration date
12/19/2018
Last updated
11/03/2022
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