Provider Demographics
NPI:1396115929
Name:WICKHAM, ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 E 100TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4013
Mailing Address - Country:US
Mailing Address - Phone:347-598-5523
Mailing Address - Fax:
Practice Address - Street 1:963 E 100TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4013
Practice Address - Country:US
Practice Address - Phone:347-598-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY698393163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse