Provider Demographics
NPI:1225063969
Name:WILKES, ANNE CORCORAN (CNM)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CORCORAN
Last Name:WILKES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 N FRESNO ST
Mailing Address - Street 2:STE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5268
Mailing Address - Country:US
Mailing Address - Phone:559-265-4444
Mailing Address - Fax:559-265-4454
Practice Address - Street 1:6225 N FRESNO ST
Practice Address - Street 2:STE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5268
Practice Address - Country:US
Practice Address - Phone:559-265-4444
Practice Address - Fax:559-265-4454
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1002363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029520Medicaid
CALAB73144FMedicaid
CA1760479745OtherCORPORATION NPI NUMBER
CALAB73144FMedicaid
CA1002Medicare UPIN