Provider Demographics
NPI:1093244030
Name:WILKINSON, BROOKE (CPNP-PC, RN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:CPNP-PC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HAVEN AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2638
Mailing Address - Country:US
Mailing Address - Phone:530-848-0583
Mailing Address - Fax:
Practice Address - Street 1:120 HAVEN AVE APT 25
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2638
Practice Address - Country:US
Practice Address - Phone:530-848-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723746-1163WP0200X
NYF382818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics