Provider Demographics
NPI:1780373522
Name:WICKLUND, PATTI ANNETTE (FNP-BC)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:ANNETTE
Last Name:WICKLUND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 CASTILLO ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5308
Mailing Address - Country:US
Mailing Address - Phone:805-682-2541
Mailing Address - Fax:805-563-0969
Practice Address - Street 1:117 PIRIE RD STE D
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3166
Practice Address - Country:US
Practice Address - Phone:805-646-7246
Practice Address - Fax:805-646-8936
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95022364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily