Individual
MELINDA SUE HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, AGNP-C, CWON
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 678-2218
Mailing address
355 S BRIDGE ST, BANNER, IL 61520-9307
(309) 650-0615
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
209027429
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
AG09220121
IL
Other
Enumeration date
11/08/2022
Last updated
05/13/2025
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