| Doctor Name: | LYDIA WICKS |
| NPI Number: | 1003175506 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE |
| License Number: | 204294 |
| Business Practice Address: | 339 Morris Ave Bronx, NY - 104516122 |
| Business Phone Number: | 7185852100 |
| Business Fax Number: | 7185858316 |
| Mailing Address: | 339 Morris Ave, BRONX |
| State: | NY |
| Postal Code: | 104516122 |
| Phone Number: | 7185852100 |
| Fax Number: | 7185858316 |
| NPI Enumeration Date: | 05/04/2012 |
| NPI Last Update Date: | 05/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | 204294 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |