Individual provider · Type 1 NPI
Stephanie Wickman, APN
Adult Health Nurse Practitioner · Prairie Grove, IL
NPI number
1780052423
Active
Practice location
3801 W Conestoga Trl
Prairie Grove, IL 60012-2081
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner Primary | 363LA2200X | 209012707 (IL) |
Adult Health Nurse Practitioner: Definition to come...
About NPI 1780052423
Stephanie Wickman, APN's National Provider Identifier is 1780052423, issued on Sep 11, 2015. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Prairie Grove, IL. The record was last updated on Sep 11, 2015.