Basic Information
| Provider Information | |||||||||
| NPI: | 1134430614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILKINSON | ||||||||
| FirstName: | LOIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1016 HARDIN HILL LN | ||||||||
| Address2: | |||||||||
| City: | KNIGHTDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275456327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196563210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 N WINSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524513411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 11/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 2013-00083 | NC | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.