Individual
MRS. STEPHANIE WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3801 W CONESTOGA TRL, PRAIRIE GROVE, IL 60012-2081
(847) 209-0128
Mailing address
3801 W CONESTOGA TRL, PRAIRIE GROVE, IL 60012-2081
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209012707
IL
Other
Enumeration date
09/11/2015
Last updated
09/11/2015
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