Provider Demographics
NPI:1669459301
Name:NICKMAN, STEVEN EUGENE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EUGENE
Last Name:NICKMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-3043
Mailing Address - Fax:
Practice Address - Street 1:8TH AVENUE & C STREET
Practice Address - Street 2:LDS HOSPITAL E8/IBMT PROGRAM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-408-1931
Practice Address - Fax:801-408-3072
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT276391-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical