Provider Demographics
NPI:1639166564
Name:WILKINSON, ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-458-1390
Mailing Address - Fax:518-459-3271
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-458-1390
Practice Address - Fax:518-459-3271
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02585422Medicaid
NYRB3869Medicare PIN
NY02585422Medicaid