| NPI | 1578574067 |
|---|---|
| Former Name | DIANNE WICKHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-100581) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-100581) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2017-02-13 |