Provider Demographics
NPI:1043651904
Name:WILKINSON, EUGENIA ALEX (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:ALEX
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 PEARL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1610
Mailing Address - Country:US
Mailing Address - Phone:508-985-8035
Mailing Address - Fax:
Practice Address - Street 1:450 PEARL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1610
Practice Address - Country:US
Practice Address - Phone:508-985-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277531363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health