Provider Demographics
NPI:1609062496
Name:WICKS, CHELSEA STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:STEWART
Last Name:WICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-6021
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934134OtherCAQH
NV1609062496Medicaid