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Individual

ANDREA LEIGH WICKUS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
5 S CENTRE AVENUE, LEESPORT, PA 19533
(610) 926-5707
(610) 926-8352
Mailing address
5 S CENTRE AVE, LEESPORT, PA 19533-8653
(610) 926-5707
(610) 926-8352

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
OA005642
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
50053971
CAPITAL BLUE CROSS
PA
Enumeration date
04/18/2006
Last updated
01/20/2023
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