Provider Demographics
NPI:1043443658
Name:WICKS, ETHEL MAY (RN)
Entity Type:Individual
Prefix:MISS
First Name:ETHEL
Middle Name:MAY
Last Name:WICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6882 N 61ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5402
Mailing Address - Country:US
Mailing Address - Phone:414-760-6282
Mailing Address - Fax:414-445-3893
Practice Address - Street 1:6882 N 61ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5402
Practice Address - Country:US
Practice Address - Phone:414-760-6282
Practice Address - Fax:414-445-3893
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114599-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse