Individual
SUE ANN BICKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
615 N MICHIGAN ST FL 1, SOUTH BEND, IN 46601-1033
(574) 647-3050
(574) 647-1094
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
71009218A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201026570
—
IN
01
—
261970120
MEDICARE PTAN
IN
Enumeration date
05/11/2011
Last updated
03/30/2021
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