Provider Demographics
NPI:1811198849
Name:WILKINS, ELWOOD FRANK JR (CRNA)
Entity Type:Individual
Prefix:
First Name:ELWOOD
Middle Name:FRANK
Last Name:WILKINS
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11380 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:MI
Mailing Address - Zip Code:48835-9142
Mailing Address - Country:US
Mailing Address - Phone:989-291-3261
Mailing Address - Fax:
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9235
Practice Address - Country:US
Practice Address - Phone:989-291-3261
Practice Address - Fax:989-291-5350
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704124864367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2828882Medicaid