Provider Demographics
NPI:1043476377
Name:WILKERSON, MICHELE ROSE (ND)
Entity Type:Individual
Prefix:MISS
First Name:MICHELE
Middle Name:ROSE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:R
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:254 GIBSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678
Mailing Address - Country:US
Mailing Address - Phone:916-351-9355
Mailing Address - Fax:916-351-5600
Practice Address - Street 1:254 GIBSON DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-351-9355
Practice Address - Fax:916-351-5600
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-1013175F00000X
CAND-312175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath