Individual
KELLEY WICHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
710 COMMERCE DR, WOODBURY, MN 55125-4919
(320) 223-9893
Mailing address
710 COMMERCE DR, WOODBURY, MN 55125-4919
(320) 223-9893
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
169459
MN
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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