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General NPI Number Information
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NPI Number | 1952457467
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Entity Type | Individual
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Provider Name | MARY WYCKOFF PHD, ACNP, BC, NNP
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 2315 STOCKTON AVE
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 916-703-3395
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Fax |
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Provider Business Mailing Address
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Address Line | 5373 MONALEE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95819
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Country | US
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Telephone | 305-904-3661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1703712
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 21525
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21525
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 21525
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 3812
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License Number State | CA
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