Individual
DEJANAE SHAQUELLE WEICKUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
721 FAWCETT AVE, TACOMA, WA 98402-5502
(253) 597-6728
Mailing address
14124 MERIDIAN E APT I107, PUYALLUP, WA 98373-6101
(253) 239-7998
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN61353026
WA
164W00000X
Licensed Practical Nurse
LP61053332
WA
Other
Enumeration date
06/22/2020
Last updated
10/04/2022
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