Provider Demographics
NPI:1225380983
Name:WICKER, JESSICA NICOLE
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:NICOLE
Last Name:WICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-7732
Mailing Address - Country:US
Mailing Address - Phone:440-228-3013
Mailing Address - Fax:
Practice Address - Street 1:923 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-7732
Practice Address - Country:US
Practice Address - Phone:440-228-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTD980374374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide