Individual
STEVEN WICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-3076
(864) 455-4135
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
217411
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
21030
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN2686
—
SC
Enumeration date
11/30/2016
Last updated
11/12/2021
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