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Individual

SHANA ROSE WICKLUND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1672 S COUNTY TRL STE 302, EAST GREENWICH, RI 02818-5099
(401) 336-3770
Mailing address
25 BROOKWOOD DR, NORTH SCITUATE, RI 02857-1576
(401) 787-4684

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
363AS0400X
Surgical Physician Assistant
Primary

Other

Enumeration date
04/29/2020
Last updated
11/06/2023
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