Individual
FREDERICK WICKWIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7150 CLEARVISTA DRIVE, INDIANAPOLIS, IN 46256-1695
(317) 621-5890
(317) 355-2205
Mailing address
9834 NORTHWIND DR, INDIANAPOLIS, IN 46256-9343
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28115235A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000108959
ANTHEM
IN
05
—
100358680
—
IN
Enumeration date
11/17/2005
Last updated
01/24/2018
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