| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SUPRENA LENISE HICKMAN | 1679241442 | 2021-10-10 |
Suprena Lenise Hickman is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1679241442.
| Entity Type | Individual |
| Provider Name | Suprena Lenise Hickman RN, BSN, MBA |
| Other Provider Name | Suprena Lenise Hickman |
| Practice Office Address | 201 N FRONT ST STE 615 WILMINGTON, NC US |
| Practice Office Telephone | 9107695855 |
| Practice Office Fax | 9102223049 |
| Mailing Address | 201 N FRONT ST STE 615 WILMINGTON, NC 284015091 US |
| Business Telephone | 9107695855 |
| Business Fax | 9102223049 |
| NPI [] | NPI | Direct |
| Code | Practice | License No State |
|---|---|---|
| 171400000X PRIMARY | 186594
NC | |
| 193200000X MULT | Group Code |