Individual
MRS. BONNIE WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
717 N 190TH PLZ, STE. 1100, ELKHORN, NE 68022-3913
(402) 815-1700
(402) 815-1959
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1631
NE
363AM0700X
Medical Physician Assistant
1631
NE
363AS0400X
Surgical Physician Assistant
1631
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026301600
—
NE
05
—
10026480100
—
NE
05
—
47068731799
—
NE
Enumeration date
02/02/2012
Last updated
11/17/2016
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