Provider Demographics
NPI:1932871845
Name:WICKARD, CHELSEA (APRN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:WICKARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 NW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68524-1403
Mailing Address - Country:US
Mailing Address - Phone:308-224-1102
Mailing Address - Fax:
Practice Address - Street 1:701 PINNACLE DR STE 105
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6228
Practice Address - Country:US
Practice Address - Phone:402-505-7989
Practice Address - Fax:402-932-8863
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner