Provider Demographics
NPI:1871088161
Name:WILKINSON-FLIESLER, ANNE E (CREDENTIALED SCHOOL)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:WILKINSON-FLIESLER
Suffix:
Gender:F
Credentials:CREDENTIALED SCHOOL
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:E
Other - Last Name:FLIESLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:408 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2614
Mailing Address - Country:US
Mailing Address - Phone:831-566-0041
Mailing Address - Fax:831-429-3450
Practice Address - Street 1:405 OLD SAN JOSE RD
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2213
Practice Address - Country:US
Practice Address - Phone:831-429-3410
Practice Address - Fax:831-429-3450
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170056290163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA170056290OtherCTC
CA30799OtherCA BRN
CA321813OtherCA BRN