Individual
BETHANY WICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(313) 745-3000
Mailing address
4201 ST ANTOINE UHC 4B, DETROIT, MI 48201
(313) 745-0937
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704088774
MI
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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