Provider Demographics
NPI:1821618364
Name:WICKER, DANA MARIE (WHNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:WICKER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 RIVER PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1162
Mailing Address - Country:US
Mailing Address - Phone:512-473-8300
Mailing Address - Fax:
Practice Address - Street 1:6611 RIVER PLACE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1162
Practice Address - Country:US
Practice Address - Phone:512-473-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145911363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology