Provider Demographics
NPI:1013627454
Name:WILKINSON, MARY NOELLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:NOELLE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:NOELLE
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:115 ROUTE 284 APT 1
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10988-2018
Mailing Address - Country:US
Mailing Address - Phone:845-341-8031
Mailing Address - Fax:
Practice Address - Street 1:115 ROUTE 284 APT 1
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10988-2018
Practice Address - Country:US
Practice Address - Phone:845-341-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483480-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse