Individual
MR. ROBERT CHRISTOPHER WICKLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1 KETTLE POINT AVE, EAST PROVIDENCE, RI 02914-5375
(401) 457-1500
Mailing address
PO BOX 1119, PROVIDENCE, RI 02901-1119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01222
RI
Other
Enumeration date
03/17/2020
Last updated
11/01/2021
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