| Doctor Name: | ELLICE ANN WICKWIRE |
| NPI Number: | 1386081115 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 041.276442 |
| Business Practice Address: | 907 S Main St Pinckneyville, IL - 622741700 |
| Business Phone Number: | 6183575371 |
| Business Fax Number: | 6183573190 |
| Mailing Address: | Po Box 49, PINCKNEYVILLE |
| State: | IL |
| Postal Code: | 622740049 |
| Phone Number: | 6183575371 |
| Fax Number: | 6183573190 |
| NPI Enumeration Date: | 06/03/2013 |
| NPI Last Update Date: | 06/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 041.276442 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |