Individual
ERIK MATTHEWS WICKSTRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2781
(719) 584-4000
Mailing address
6638 COTTONWOOD TREE DR, COLORADO SPRINGS, CO 80927-4061
(904) 502-2310
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C-APN.0001896-C-CRNA
CO
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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