Individual
JAN MIRIAM JACOB-WICKLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
615 S NEW BALLAS RD DEPT OF, SAINT LOUIS, MO 63141-8221
(314) 251-6000
(636) 386-7679
Mailing address
1054 BIG BEND STATION DR, MANCHESTER, MO 63088-1429
(636) 861-1102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
119559
MO
Other
Enumeration date
03/16/2007
Last updated
02/20/2019
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