Healthcare Provider Details

I. General information

NPI: 1558172114
Provider Name (Legal Business Name): ANNA WICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CENTER AVE
SOMERSET PA
15501-2033
US

IV. Provider business mailing address

840 WOOD ST
CLARION PA
16214-1240
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number789509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: