Individual
MR. TAL D WICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EMT-B
Contact information
Practice address
LYSTER ARMY HEALTH CLINIC, BLDG 301, ANDREWS AVE, FORT RUCKER, AL 36362-5333
(334) 255-7754
Mailing address
LYSTER ARMY HEALTH CLINIC, BLDG 301, ANDREWS AVE, FORT RUCKER, AL 36362-5333
(334) 255-7754
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
B1719026
AL
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
12/02/2009
Last updated
12/03/2009
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