Individual
HOLLIE WICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1601 NW 114TH ST, CLIVE, IA 50325-7007
(515) 222-7000
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-4374
(515) 643-2784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001753
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27468
WELLMARK BLUE SHIELD
IA
01
—
70932
WELLMARK BLUE SHIELD
IA
01
—
P000429806
RAILROAD MEDICARE
IA
Enumeration date
10/10/2006
Last updated
02/12/2008
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