Provider Demographics
NPI:1174013619
Name:WICKLUND, ANNA KATHERINE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHERINE
Last Name:WICKLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 NORTH EMERALD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3969
Mailing Address - Country:US
Mailing Address - Phone:715-573-8356
Mailing Address - Fax:
Practice Address - Street 1:2606 STEWART AVE STE 100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5449
Practice Address - Country:US
Practice Address - Phone:715-847-0000
Practice Address - Fax:715-847-2775
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8400363L00000X
WI8400-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily