Provider Demographics
NPI:1770098378
Name:WILKINSON, ELIZABETH GRACE (MSN, FNP-BC, RNC-OB)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MSN, FNP-BC, RNC-OB
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:GRACE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3711 LONG BEACH BLVD., STE 700
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3353
Mailing Address - Country:US
Mailing Address - Phone:562-634-8812
Mailing Address - Fax:562-424-8770
Practice Address - Street 1:3711 LONG BEACH BLVD., STE 700
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3353
Practice Address - Country:US
Practice Address - Phone:562-634-8812
Practice Address - Fax:562-424-8770
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006946363L00000X
CA95006946363LF0000X, 363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health