Organization
WICKFORD FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAXWELL HOGUE NURSE PRACTITIONER (OWNER)
(603) 667-6765
Entity
Organization
Contact information
Practice address
320 PHILLIPS ST STE 102, NORTH KINGSTOWN, RI 02852-5149
(603) 667-6765
Mailing address
619 BOSTON NECK RD, NORTH KINGSTOWN, RI 02852-6235
(603) 667-6765
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235789231
—
RI
01
—
APRN02399
STATE NP LICENSE
RI
Enumeration date
12/12/2022
Last updated
02/01/2023
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