Most Relevant Information
Provider Data
| NPI Number: | 1003265364 |
| Provider Name: | ROSS WICKSTROM |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | COA.19152-NP |
Most Important Dates
| Enumeration Date: | 06/08/2016 |
| Last Updated: | 06/08/2016 |
Provider Practice Location
1184 W LOCUST ST
WILMINGTON
OH
451772009
Practice Location Phone/Fax
| Phone: | 9373821616 |
| Fax: |
Provider Mailing Location
1184 W LOCUST ST
WILMINGTON
OH
451772009
Provider Mailing Phone/Fax
| Phone: | 9373821616 |
| Fax: |