Healthcare Provider Details

I. General information

NPI: 1093244030
Provider Name (Legal Business Name): BROOKE WILKINSON CPNP-PC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HAVEN AVE APT 25
NEW YORK NY
10032-2638
US

IV. Provider business mailing address

120 HAVEN AVE APT 25
NEW YORK NY
10032-2638
US

V. Phone/Fax

Practice location:
  • Phone: 530-848-0583
  • Fax:
Mailing address:
  • Phone: 530-848-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number723746-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF382818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: