Provider Demographics
NPI:1558709733
Name:WILKINSON, ELAINE SANDRA (LAC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:SANDRA
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CLOVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2709
Mailing Address - Country:US
Mailing Address - Phone:607-244-8030
Mailing Address - Fax:
Practice Address - Street 1:64 CLOVERLAND DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2709
Practice Address - Country:US
Practice Address - Phone:585-709-1482
Practice Address - Fax:585-348-2181
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist