Provider Demographics
NPI:1740481126
Name:WICKER, ANJANETTE PANNELL (RN)
Entity type:Individual
Prefix:MRS
First Name:ANJANETTE
Middle Name:PANNELL
Last Name:WICKER
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 1:1532 S 850 E
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-8148
Mailing Address - Country:US
Mailing Address - Phone:317-462-0950
Mailing Address - Fax:
Practice Address - Street 1:1400 N RITTER AVE STE 211
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3046
Practice Address - Country:US
Practice Address - Phone:317-355-6890
Practice Address - Fax:317-355-6916
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28097347A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse