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General NPI Number Information
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NPI Number | 1720507387
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE WILKS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 1923 N DAL PASO ST STE A
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City | HOBBS
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State | NM
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Zip | 88240-3023
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Country | US
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Telephone | 575-433-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 4904 N BREANNA ST
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City | HOBBS
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State | NM
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Zip | 88242-9811
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-03378
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License Number State | NM
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