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General NPI Number Information
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NPI Number | 1508487737
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Entity Type | Individual
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Provider Name | NICOLE WILKERSON
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Gender | Female
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 1000 INDIAN ROCK DAM RD
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City | YORK
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State | PA
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Zip | 17403-5200
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Country | US
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Telephone | 717-271-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BETHLEHEM LN
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City | EPHRATA
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State | PA
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Zip | 17522-9174
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT007153
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License Number State | PA
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