Provider Demographics
NPI:1508338328
Name:WICKERSHAM, ERIN (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WICKERSHAM
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 470D
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4009
Practice Address - Country:US
Practice Address - Phone:856-341-8250
Practice Address - Fax:856-341-8251
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA988442133V00000X
NJ988442133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered