Individual
TAMARA LYNN HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY, 220 W. GARFIELD STREET, CHARLEVOIX, MI 49720
(231) 547-6523
(231) 547-6238
Mailing address
8275 W STATE ST, CENTRAL LAKE, MI 49622-9701
(231) 544-6960
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704113645
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4868054
—
MI
01
—
50-0-A5-1010-0
BCBSM
MI
01
—
TH113645
BCBSM LICENSE NUMBER
MI
Enumeration date
05/09/2007
Last updated
06/28/2016
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