Provider Demographics
NPI:1679938138
Name:HICKERSON, NANCY (BSRN, PHN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:BSRN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SUMMER ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2648
Mailing Address - Country:US
Mailing Address - Phone:612-617-4600
Mailing Address - Fax:
Practice Address - Street 1:2000 SUMMER ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2648
Practice Address - Country:US
Practice Address - Phone:612-617-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-153677-7163W00000X
MN14602163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health