Individual
ELLICE ANN WICKWIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
907 S MAIN ST, PINCKNEYVILLE, IL 62274-1700
(618) 357-5371
(618) 357-3190
Mailing address
PO BOX 49, PINCKNEYVILLE, IL 62274-0049
(618) 357-5371
(618) 357-3190
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
041.276442
IL
Other
Enumeration date
06/03/2013
Last updated
06/03/2013
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