Individual
MARY WICKENHEISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704323822
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245303890
—
MI
Enumeration date
08/08/2017
Last updated
04/16/2018
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