Individual
MRS. ASHLEY SHAVON WICKWIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10905 CLAREMONT AVE NE, ALBUQUERQUE, NM 87112-1606
(505) 712-0122
Mailing address
10905 CLAREMONT AVE NE, ALBUQUERQUE, NM 87112-1606
(505) 712-0122
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
7130
NM
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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