Doctor Name: | KAREN WICKERT |
NPI Number: | 1033197330 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 331602 |
Business Practice Address: | 4077 West Rd Cortland, NY - 130451637 |
Business Phone Number: | 6077539977 |
Business Fax Number: | 6077537311 |
Mailing Address: | 4077 West Rd, CORTLAND |
State: | NY |
Postal Code: | 130451637 |
Phone Number: | 6077539977 |
Fax Number: | 6077537311 |
NPI Enumeration Date: | 01/06/2006 |
NPI Last Update Date: | 04/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 331602 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |