Individual
MRS. ANGELINE MARIE WICKLIFFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
1001 S MAPLE AVE, TAHLEQUAH, OK 74464-5127
(918) 207-5688
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
91177
OK
Other
Enumeration date
12/10/2010
Last updated
01/05/2011
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