| Doctor Name: | DENA C WICH |
| NPI Number: | 1902101637 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | SP010782 |
| Business Practice Address: | 14351 Kutztown Rd Fleetwood, PA - 195229273 |
| Business Phone Number: | 6109448800 |
| Business Fax Number: | 6109448213 |
| Mailing Address: | Po Box 783311, PHILADELPHIA |
| State: | PA |
| Postal Code: | 191783311 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2011 |
| NPI Last Update Date: | 12/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP010782 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |