Provider Demographics
NPI:1639488075
Name:WILGING, DANA M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:M
Last Name:WILGING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:DIMILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 ATRISCO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1627
Mailing Address - Country:US
Mailing Address - Phone:505-462-7575
Mailing Address - Fax:
Practice Address - Street 1:3901 ATRISCO DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1627
Practice Address - Country:US
Practice Address - Phone:505-462-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA213696363A00000X
NMPA2010-0071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant