Doctor Name: | JUDITH HELEN WIKSTROM |
NPI Number: | 1831180199 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | NP22259 |
Business Practice Address: | 241 Church St Hayesville, NC - 289049688 |
Business Phone Number: | 8283896383 |
Business Fax Number: | 8283892322 |
Mailing Address: | Po Box 1309, HAYESVILLE |
State: | NC |
Postal Code: | 289041309 |
Phone Number: | 8283896383 |
Fax Number: | 8283892322 |
NPI Enumeration Date: | 11/03/2005 |
NPI Last Update Date: | 04/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP22259 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |