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General NPI Number Information
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NPI Number | 1639488075
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Entity Type | Individual
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Provider Name | DANA M WILGING PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 3901 ATRISCO DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1627
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Country | US
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Telephone | 505-462-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 ATRISCO DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1627
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Country | US
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Telephone | 505-462-7575
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA213696
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2010-0071
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License Number State | NM
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