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1710716824
LACEY WICKERSHAM
ONTARIO, OR
NPI
1710716824
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Entity Type
Individual
Gender
N/A
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: OR 10026939)
Enumeration Date
2024-07-29
Last Update Date
2024-07-29
Business Address
LACEY WICKERSHAM APRN
896 FORTNER ST
ONTARIO, OR 97914-1787
Phone number: 541-881-2828
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Mailing Address
LACEY WICKERSHAM APRN
896 FORTNER ST
ONTARIO, OR 97914-1787
Phone number: 541-881-2828
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