Provider Demographics
NPI:1194885467
Name:WILKINS, CHRISTOPHER SHEAN (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHEAN
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 GREENWICH CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-2800
Mailing Address - Country:US
Mailing Address - Phone:925-628-6556
Mailing Address - Fax:925-828-5084
Practice Address - Street 1:103 GREENWICH CT
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-2800
Practice Address - Country:US
Practice Address - Phone:925-628-6556
Practice Address - Fax:925-828-5084
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12886363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ14450ZMedicare PIN