| NPI | 1568859601 |
|---|---|
| Former Name | AMY MARIE WICKHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO05242) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2022-12-01 |