Individual
MRS. COLETTE WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
850 ELM ST, ELKO, NV 89801-3349
(775) 753-2490
Mailing address
160 SAGE ST, ELKO, NV 89801-2820
(775) 753-2490
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0000033136
NV
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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