Provider Demographics
NPI:1093720716
Name:WILKINSON, LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PORTER DR
Mailing Address - Street 2:PO BOX 357
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8501
Mailing Address - Country:US
Mailing Address - Phone:802-388-8805
Mailing Address - Fax:802-388-5619
Practice Address - Street 1:116 PORTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8501
Practice Address - Country:US
Practice Address - Phone:802-388-8805
Practice Address - Fax:802-388-5619
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334746363L00000X
VT101-0060890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017866Medicaid
NY00630039Medicaid
001959201Medicare PIN