Individual
KATHERINE MARIE WICKSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1099 HELMO AVE N STE 100, OAKDALE, MN 55128-6034
(651) 326-5300
Mailing address
2828 HIGHWAY 88, ST ANTHONY, MN 55418-3243
(605) 254-3402
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F06242189
MN
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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