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Individual

JILLIAN MARIE WICKHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
325 W 15TH ST, NEW YORK, NY 10011-5903
(212) 604-6000
Mailing address
301 RIDGE AVE, CLARENDON HILLS, IL 60514-1312

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary

Other

Enumeration date
05/31/2022
Last updated
05/31/2022
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