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Malissa D Wickersham, FNP
Family Nurse Practitioner in Groton, Connecticut
NPI 1992005623

Malissa D Wickersham is a Family Nurse Practitioner based in Groton, CT and is specialized in Family. Malissa D Wickersham practices in Groton, CT and has the professional credentials of FNP. The NPI Number for Malissa D Wickersham is 1992005623 and holds a License No. CP000606 (Connecticut).

The current practice location address for Malissa D Wickersham is 1 Wahoo Ave, Groton, CT and can be reached out via phone at 860-694-7521.

Location: 1 Wahoo Ave, Groton, CT, 06349-2324
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1992005623
Provider Name
Malissa D Wickersham
Credential
FNP
Provider Entity Type
Individual
Gender
Female
Address
1 Wahoo Ave, Groton, CT, 06349-2324
Phone Number
860-694-7521
Fax Number
Provider Enumeration Date
10/28/2010
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1 Wahoo Ave
City
Groton
State
Connecticut
Zip
06349-2324
Phone Number
860-694-7521
Fax Number
person
Provider Business Mailing Address Details
Address
1 Wahoo Ave
City
Groton
State
Connecticut
Zip
06349-2324
Phone Number
860-694-7521
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
CP000606 (South Dakota)
Definition
Definition to come...
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