Healthcare Provider Details

I. General information

NPI: 1053871012
Provider Name (Legal Business Name): EMILY ELIZABETH WIKNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 1100
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

1120 TRANTWOOD AVE
VIRGINIA BEACH VA
23454-1917
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6200
  • Fax:
Mailing address:
  • Phone: 443-812-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101281712
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: