Provider Demographics
NPI:1306518493
Name:WILKINSON-ST.FORT, RENEE (RN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:WILKINSON-ST.FORT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1135
Mailing Address - Country:US
Mailing Address - Phone:516-323-3467
Mailing Address - Fax:
Practice Address - Street 1:1000 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1135
Practice Address - Country:US
Practice Address - Phone:516-323-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563136-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse