Most Relevant Information
Provider Data
| NPI Number: | 1003175506 |
| Provider Name: | LYDIA WICKS NURSE |
| Entity Type: | Individual |
| Taxonomy Code: | 163WS0200X |
| Specialty: | Registered Nurse |
| License Number: | 204294 |
Most Important Dates
| Enumeration Date: | 05/04/2012 |
| Last Updated: | 05/04/2012 |
Provider Practice Location
339 MORRIS AVE
BRONX
NY
104516122
Practice Location Phone/Fax
| Phone: | 7185852100 |
| Fax: | 7185858316 |
Provider Mailing Location
339 MORRIS AVE
BRONX
NY
104516122
Provider Mailing Phone/Fax
| Phone: | 7185852100 |
| Fax: | 7185858316 |