Provider Demographics
NPI:1962180067
Name:WICKENS, DENEICE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DENEICE
Middle Name:
Last Name:WICKENS
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 TIDEWATER DR APT 125
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-0015
Mailing Address - Country:US
Mailing Address - Phone:803-565-9758
Mailing Address - Fax:
Practice Address - Street 1:2551 ELTHAM AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2514
Practice Address - Country:US
Practice Address - Phone:757-622-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187449363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health