Kelsey Wickenhauser, PA

NPI #1972849321 in Godfrey, Illinois

Provider Information

NPI Number: 1972849321
Entity Type: Individual
Name: Kelsey Wickenhauser, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Dec 12, 2012
Last Updated: May 13, 2014

Practice Location

Address: 1368 DADRIAN PROFESSIONAL PARK
City: Godfrey
State: Illinois
ZIP Code: 62035-1685
Phone: (309) 530-9841

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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