Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60961155 | WA |
NPI | 1013469592 |
---|---|
Provider Name | Dr. Timothy C Wical JR. |
First Address | Bethesda, MD 20814-4712 |
Second Address | Puyallup, WA 98375-9504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2016 |
Last Update Date | 21/10/2020 |