Provider Demographics
NPI:1982223624
Name:WICKERSHAM, ERIC WILLIAM (CRNP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:WICKERSHAM
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BLDG A STE 5
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-696-2850
Mailing Address - Fax:610-696-7159
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BLDG A STE 5
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-696-2850
Practice Address - Fax:610-696-7159
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021407363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care