Provider Demographics
NPI:1285162693
Name:WICKLINE, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:WICKLINE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-0590
Mailing Address - Country:US
Mailing Address - Phone:304-772-3064
Mailing Address - Fax:304-772-3296
Practice Address - Street 1:142 JAMES MONROE DR
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7168
Practice Address - Country:US
Practice Address - Phone:304-753-5940
Practice Address - Fax:304-753-5941
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2025-01-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant