Wickwire, Frederick

Wickwire, Frederick is an individual health care provider with primary practice located at 7150 Clearvista Drive , Indianapolis IN 46256-1695. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Wickwire, Frederick can be contacted via phone (317) 621-5890.

Contact Information

Primary practice address
7150 Clearvista Drive Indianapolis IN 46256-1695
Phone: (317) 621-5890
Fax: (317) 355-2205
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 28115235A Indiana

Profile Details

NPI number 1265414965
LBN Legal business name Wickwire, Frederick
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Jan 24th, 2018 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265414965 NPPES
Indiana Other 000000108959 ANTHEM
Indiana MEDICAID 100358680 ANTHEM

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