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Individual

DEBORAH LYNN WICKENDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN,NP

Contact information

Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Mailing address
2401 VALLEY DR, VALPARAISO, IN 46383-2520

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002529A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
71002529A
INDIANA NP LICENSE
IN
Enumeration date
11/13/2007
Last updated
03/29/2023
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