Individual
CARRIE LEE WICKWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDE
Contact information
Practice address
750 S BASCOM AVE, DIABETES ED, SAN JOSE, CA 95128-2603
(408) 885-5000
Mailing address
1590 QUEENSBURY AVE, LOS ALTOS, CA 94024-5843
(650) 903-0889
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
RNH321148
CA
Other
Enumeration date
06/06/2007
Last updated
07/08/2007
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