Provider Demographics
NPI:1891715447
Name:WILKINSON, THERESE M (NP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:MHMC-SURGERY/GENERAL
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-7359
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:MHMC-SURGERY/GENERAL
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2222142Medicaid
OHDONP76061Medicare ID - Type Unspecified
OH2222142Medicaid