Healthcare Provider Details

I. General information

NPI: 1346063906
Provider Name (Legal Business Name): ANGELA WILBANKS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 E MAYFLOWER LN STE 4
WASILLA AK
99654-7891
US

IV. Provider business mailing address

5431 E MAYFLOWER LN STE 4
WASILLA AK
99654-7891
US

V. Phone/Fax

Practice location:
  • Phone: 888-382-1897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number229628
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: