Healthcare Provider Details

I. General information

NPI: 1659319291
Provider Name (Legal Business Name): CHERYL A WICKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E ELM ST
GRAHAM NC
27253-3022
US

IV. Provider business mailing address

2920 TAVISTOCK DR
DURHAM NC
27712-1047
US

V. Phone/Fax

Practice location:
  • Phone: 336-226-2448
  • Fax: 336-226-5894
Mailing address:
  • Phone: 919-383-5818
  • Fax: 336-226-5894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: