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1992005623
MALISSA D WICKERSHAM
GROTON, CT
NPI
1992005623
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Former Name
MALISSA D FLYNN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: SD CP000606)
Enumeration Date
2010-10-28
Last Update Date
2019-11-18
Business Address
MALISSA D WICKERSHAM FNP
1 WAHOO AVE
GROTON, CT 06349-2324
Phone number: 860-694-7521
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Mailing Address
MALISSA D WICKERSHAM FNP
1 WAHOO AVE
GROTON, CT 06349-2324
Phone number: 860-694-7521
Copy
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