Individual
EDRIE WICHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3901 S FREMONT AVE, SPRINGFIELD, MO 65804-6538
(417) 875-3000
Mailing address
3901 S FREMONT AVE, SPRINGFIELD, MO 65804-6538
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
153616
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598933533
—
MO
05
—
427190103
—
MO
Enumeration date
02/12/2008
Last updated
01/21/2021
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