Provider Demographics
NPI:1679241442
Name:HICKMAN, SUPRENA LENISE (RN, BSN, MBA)
Entity Type:Individual
Prefix:
First Name:SUPRENA
Middle Name:LENISE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:RN, BSN, MBA
Other - Prefix:
Other - First Name:SUPRENA
Other - Middle Name:LENISE
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN, MBA
Mailing Address - Street 1:201 N FRONT ST STE 615
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5091
Mailing Address - Country:US
Mailing Address - Phone:910-769-5855
Mailing Address - Fax:910-222-3049
Practice Address - Street 1:201 N FRONT ST STE 615
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5091
Practice Address - Country:US
Practice Address - Phone:910-769-5855
Practice Address - Fax:910-222-3049
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-05
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC186594