Provider Demographics
NPI:1902815376
Name:WILKINSON, TONYA (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAKESIDE AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4939
Mailing Address - Country:US
Mailing Address - Phone:802-860-1928
Mailing Address - Fax:802-860-0192
Practice Address - Street 1:128 LAKESIDE AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4939
Practice Address - Country:US
Practice Address - Phone:802-860-1928
Practice Address - Fax:802-860-0192
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010029537363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012840Medicaid