Individual
REBECCA WICKLIFFE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
4851 W PARK DR, SUITE B, ZACHARY, LA 70791-4010
(225) 654-0310
(225) 654-0310
Mailing address
PO BOX 371, ZACHARY, LA 70791-0371
(225) 654-0310
(225) 654-0310
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
RN075524
LA
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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