Provider Demographics
NPI:1881896942
Name:WIKSTRAND, SVEA PERAI KAYANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:SVEA
Middle Name:PERAI KAYANN
Last Name:WIKSTRAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:13919 S. WEST BAY SHORE DRIVE
Mailing Address - Street 2:STE G-01
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-929-7450
Mailing Address - Fax:
Practice Address - Street 1:13919 S WEST BAY SHORE DR
Practice Address - Street 2:STE G-01
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6216
Practice Address - Country:US
Practice Address - Phone:231-929-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant