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Individual

NICOLE DENAE BENJAMIN REDDICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
100 THEDA CLARK MEDICAL PLZ STE 340, NEENAH, WI 54956-2763
(920) 364-3600
(920) 364-3900
Mailing address
100 THEDA CLARK MEDICAL PLZ STE 340, NEENAH, WI 54956-2763
(920) 364-3600
(920) 364-3900

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2729
WI
363A00000X
Physician Assistant
PA04542
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8Y0227
BCBS
TX
Enumeration date
08/13/2006
Last updated
08/12/2024
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