| Doctor Name: | MR. FREDRICK RYAN WILKINS |
| NPI Number: | 1023266012 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 079043837RN |
| Business Practice Address: | 913 Garden Valley Blvd Roseburg, OR - 974716523 |
| Business Phone Number: | 5414401000 |
| Business Fax Number: | 5416773189 |
| Mailing Address: | 207 Camino Nina Ave, ROSEBURG |
| State: | OR |
| Postal Code: | 974719694 |
| Phone Number: | 5414401000 |
| Fax Number: | 5416773189 |
| NPI Enumeration Date: | 09/03/2008 |
| NPI Last Update Date: | 09/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WM0705X |
| License Number: | 079043837RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Medical-Surgical |
| Taxonomy Definition: | |