Provider Demographics
NPI:1255669651
Name:WILKINSON, ANN D
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:D
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MCCUSKER DR
Mailing Address - Street 2:APT. 10
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4249
Mailing Address - Country:US
Mailing Address - Phone:617-959-0616
Mailing Address - Fax:
Practice Address - Street 1:52 MCCUSKER DR
Practice Address - Street 2:APT. 10
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4249
Practice Address - Country:US
Practice Address - Phone:617-959-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MA172V00000X COMMUNITY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker