| Doctor Name: | FUSAE M WICKS |
| NPI Number: | 1093856130 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F303020 |
| Business Practice Address: | 71 Euclid Ave Massapequa, NY - 117584507 |
| Business Phone Number: | 5167993453 |
| Business Fax Number: | |
| Mailing Address: | 71 Euclid Ave, MASSAPEQUA |
| State: | NY |
| Postal Code: | 117584507 |
| Phone Number: | 5167993453 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F303020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |