Individual
JESSICA RAYE WICHMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2650 32ND AVE S STE D, GRAND FORKS, ND 58201-6541
(701) 732-2700
(701) 732-2701
Mailing address
PO BOX 5210, GRAND FORKS, ND 58206-5210
(218) 310-2733
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10660
MN
363A00000X
Physician Assistant
Primary
PAC0628
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467147
—
ND
05
—
970004432
—
MN
Enumeration date
10/08/2009
Last updated
01/07/2020
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