Provider Demographics
NPI:1619932969
Name:WILKINS, LISA NICHOLE (MHS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICHOLE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MHS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 GLYNN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2837
Mailing Address - Country:US
Mailing Address - Phone:443-235-4165
Mailing Address - Fax:
Practice Address - Street 1:751 UKROP WAY
Practice Address - Street 2:THE COLLEGE OF WILLIAM AND MARY
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23187
Practice Address - Country:US
Practice Address - Phone:757-221-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer