Provider Demographics
NPI:1376887745
Name:WILKINS, JENNIFER
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WILKINS
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 1:34 N 6TH ST
Mailing Address - Street 2:APT N6B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3059
Mailing Address - Country:US
Mailing Address - Phone:646-552-5658
Mailing Address - Fax:
Practice Address - Street 1:34 N 6TH ST
Practice Address - Street 2:APT N6B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3059
Practice Address - Country:US
Practice Address - Phone:646-552-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637094121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist