Provider Demographics
NPI:1184815342
Name:WILKINSON, SUSAN C (PHD, RN, CNS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PHD, RN, CNS
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Mailing Address - Street 1:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-659-7290
Mailing Address - Fax:325-659-7291
Practice Address - Street 1:2018 PULLIAM ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76905-5148
Practice Address - Country:US
Practice Address - Phone:325-659-7290
Practice Address - Fax:325-659-7291
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX245826364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191554802Medicaid
TX8K0227Medicare PIN