Individual
MS. JAALA M WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2827 FORT MISSOULA RD, MISSOULA, MT 59804-7408
(406) 728-4100
Mailing address
PO BOX 1098, FRENCHTOWN, MT 59834-1098
(406) 546-3631
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
165714
MT
Other
Enumeration date
09/02/2020
Last updated
11/18/2020
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