Provider Demographics
NPI:1851420145
Name:FICKER, ANGELIC M (RN, RCS)
Entity Type:Individual
Prefix:
First Name:ANGELIC
Middle Name:M
Last Name:FICKER
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7969 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3295
Mailing Address - Country:US
Mailing Address - Phone:262-728-7747
Mailing Address - Fax:
Practice Address - Street 1:1305 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1495
Practice Address - Country:US
Practice Address - Phone:608-758-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39980400Medicaid