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Individual
STEPHANIE WICKER
Active
Individual
STEPHANIE WICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005448A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201290950
—
IN
01
—
P02198230
MEDICARE RR
IN
Enumeration date
04/30/2015
Last updated
08/21/2024
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