Provider Demographics
NPI:1144580424
Name:WILSON, ASHLEY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:ADAMKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2530 CHICAGO AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4387
Mailing Address - Country:US
Mailing Address - Phone:612-813-3300
Mailing Address - Fax:612-813-3349
Practice Address - Street 1:2530 CHICAGO AVE STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-3300
Practice Address - Fax:612-813-3349
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN662762080P0203X
NC183514208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144580424Medicaid
SCNC2443Medicaid
NC1144580424Medicaid