Provider Demographics
NPI:1861617771
Name:WICKMAN, JANE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:WICKMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UCSF SHS 500 PARNASSUS AVE
Mailing Address - Street 2:MU-H005
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-8741
Mailing Address - Fax:415-476-6137
Practice Address - Street 1:UCSF SHS 500 PARNASSUS AVE
Practice Address - Street 2:MU-H005
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-476-8741
Practice Address - Fax:415-476-6137
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373572363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health