Individual
LOUISE M WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12 WOODBINE RD, COLCHESTER, CT 06415-1883
(860) 501-0590
Mailing address
12 WOODBINE RD, COLCHESTER, CT 06415-1883
(860) 501-0590
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
113269
CT
363LA2200X
Adult Health Nurse Practitioner
Primary
12.009638
CT
Other
Enumeration date
02/19/2015
Last updated
09/06/2021
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