Healthcare Provider Details

I. General information

NPI: 1770098378
Provider Name (Legal Business Name): ELIZABETH GRACE WILKINSON MSN, FNP-BC, RNC-OB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH GRACE PRICE

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 LONG BEACH BLVD., STE 700
LONG BEACH CA
90807-3353
US

IV. Provider business mailing address

3711 LONG BEACH BLVD., STE 700
LONG BEACH CA
90807-3353
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-8812
  • Fax: 562-424-8770
Mailing address:
  • Phone: 562-634-8812
  • Fax: 562-424-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95006946
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006946
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95006946
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95006946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: