Most Relevant Information
Provider Data
| NPI Number: | 1003174533 |
| Provider Name: | LEEANN WICKENS P.A. |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 5601001022 |
Most Important Dates
| Enumeration Date: | 05/03/2012 |
| Last Updated: | 03/10/2021 |
Provider Practice Location
15855 19 MILE RD
CLINTON TWP
MI
480383504
Practice Location Phone/Fax
| Phone: | 5862031940 |
| Fax: |
Provider Mailing Location
15855 19 MILE RD
CLINTON TWP
MI
480383504
Provider Mailing Phone/Fax
| Phone: | 5862031940 |
| Fax: |