Individual
MR. LIAM ANDREW WICKENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 S EAGLE RD STE 1241, MERIDIAN, ID 83642-6355
(208) 381-6930
(208) 381-6931
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8871273
ID
Other
Enumeration date
05/29/2023
Last updated
10/15/2025
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