Provider Demographics
NPI:1093175101
Name:WILKES, JALINE
Entity Type:Individual
Prefix:
First Name:JALINE
Middle Name:
Last Name:WILKES
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 1:13944 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3804
Mailing Address - Country:US
Mailing Address - Phone:216-767-4292
Mailing Address - Fax:216-767-4274
Practice Address - Street 1:13944 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3804
Practice Address - Country:US
Practice Address - Phone:216-767-4292
Practice Address - Fax:216-767-4274
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18835-NP261QP2300X
OHAPRN.CNP.18835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care