Provider Demographics
NPI:1679966774
Name:WIKANDER, AILI NICOLE
Entity Type:Individual
Prefix:MRS
First Name:AILI
Middle Name:NICOLE
Last Name:WIKANDER
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 1:713 KELSEY LN E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9451
Mailing Address - Country:US
Mailing Address - Phone:253-380-9676
Mailing Address - Fax:
Practice Address - Street 1:713 KELSEY LN E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-9451
Practice Address - Country:US
Practice Address - Phone:253-380-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist