Individual
EMILY LOUISE WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3099
(417) 326-6000
Mailing address
19135 PAWNEE CT, SAINT JOSEPH, MO 64505-8901
(309) 258-5813
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036.177695
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1728
NE
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2024028249
MO
Other
Enumeration date
02/29/2016
Last updated
01/15/2026
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