Individual
NIKOLAS SANDQUIST WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(505) 500-5093
Mailing address
360 US HIGHWAY 1 BYP UNIT 102, PORTSMOUTH, NH 03801-7105
(603) 410-6700
(603) 319-8308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010340
IL
363A00000X
Physician Assistant
1209260
—
363A00000X
Physician Assistant
PA9559
MA
Other
Enumeration date
07/19/2023
Last updated
05/14/2024
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