Provider Demographics
NPI:1750175576
Name:WICKS, JULIA (NP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WICKS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 WILLIAMSON AVE APT 4007
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2182
Mailing Address - Country:US
Mailing Address - Phone:518-944-0859
Mailing Address - Fax:
Practice Address - Street 1:628 WILLIAMSON AVE APT 4007
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2182
Practice Address - Country:US
Practice Address - Phone:518-944-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95033266363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care