Individual
MISS BONNIE BETH WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
61250 SE COOMBS PL, BEND, OR 97702-3704
(541) 706-5930
(541) 706-5931
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
(325) 481-2104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04799
TX
Other
Enumeration date
07/19/2006
Last updated
12/03/2024
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