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1063012656
RYAN WICKERHAM
BELCOURT, ND
NPI
1063012656
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2020-10-31
Last Update Date
2020-10-31
Business Address
RYAN WICKERHAM
9862 46TH AVE NE 1191 KENT ADDITION 1191
BELCOURT, ND 58316
Phone number: 701-278-1111
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Mailing Address
RYAN WICKERHAM
PO BOX 2263
BELCOURT, ND 58316-2263
Phone number: 701-278-1111
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