Provider Demographics
NPI:1578834412
Name:WILKINSON, MICHELLE J (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELI
Other - Middle Name:J
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:982385 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-2385
Mailing Address - Country:US
Mailing Address - Phone:402-559-5873
Mailing Address - Fax:402-559-3100
Practice Address - Street 1:982385 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2385
Practice Address - Country:US
Practice Address - Phone:402-559-5873
Practice Address - Fax:402-559-3100
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant