Provider Demographics
NPI:1104508290
Name:WICKS, PAULA KU'UIPO
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:KU'UIPO
Last Name:WICKS
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 1:8 MILLIA DR
Mailing Address - Street 2:
Mailing Address - City:CRIDERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45806-2438
Mailing Address - Country:US
Mailing Address - Phone:419-860-4100
Mailing Address - Fax:
Practice Address - Street 1:8 MILLIA DR
Practice Address - Street 2:
Practice Address - City:CRIDERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45806-2438
Practice Address - Country:US
Practice Address - Phone:419-860-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant