Provider Demographics
NPI:1053070250
Name:WIMBERLY, DEILILIAH
Entity Type:Individual
Prefix:
First Name:DEILILIAH
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 S RAVINIA DR APT 204
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5710
Mailing Address - Country:US
Mailing Address - Phone:414-430-6929
Mailing Address - Fax:
Practice Address - Street 1:4260 S RAVINIA DR APT 204
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5710
Practice Address - Country:US
Practice Address - Phone:414-430-6929
Practice Address - Fax:414-763-6598
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator