Individual
JOHN T HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2636
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2636
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
64204
ID
Other
Enumeration date
04/02/2026
Last updated
04/02/2026
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