Individual
KATHY L WIELICZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CPNP
Contact information
Practice address
1ST FLOOR WOOD CENTER, 34TH & CIVIC CENTER BLVD, PHILADELPHIA, PA 19104
(215) 590-3440
Mailing address
6 GREENHILL CT, MARLTON, NJ 08053-5379
(856) 797-6591
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
26NR09657400
NJ
363LP0200X
Pediatric Nurse Practitioner
Primary
SP059690
PA
Other
Enumeration date
11/04/2005
Last updated
08/14/2007
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