Individual
TARA NICKUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2080 ERION RD, BATAVIA, OH 45103-8928
(513) 403-4497
Mailing address
2080 ERION RD, BATAVIA, OH 45103-8928
(513) 403-4497
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3011176
KY
363L00000X
Nurse Practitioner
Primary
APRNCNP020769
OH
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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