Provider Demographics
NPI:1457021008
Name:WILKISON, ANGELA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:WILKISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6439 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-8437
Mailing Address - Country:US
Mailing Address - Phone:810-919-3005
Mailing Address - Fax:
Practice Address - Street 1:6439 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-8437
Practice Address - Country:US
Practice Address - Phone:810-919-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse