Individual
MARTHA DAMRON WICKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5001 WESTBANK EXPY, MARRERO, LA 70072
(504) 349-8708
(504) 329-8703
Mailing address
3300 W ESPLANADE AVE, SUITE 213, METAIRIE, LA 70002
(504) 838-5716
(504) 838-5714
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
010966
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1696374
—
LA
Enumeration date
07/29/2006
Last updated
07/08/2007
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