LACEY WICKERSHAM

ONTARIO, OR
NPI1710716824
Entity TypeIndividual
GenderN/A
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: OR  10026939)
Enumeration Date2024-07-29
Last Update Date2025-01-02
Business Address
LACEY WICKERSHAM APRN
896 FORTNER ST
ONTARIO, OR 97914-1787
Phone number: 541-881-2828
Mailing Address
LACEY WICKERSHAM APRN
1441 NE 10TH AVE
PAYETTE, ID 83661-5420
Phone number: 541-881-2828
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