Provider Demographics
NPI:1558944801
Name:WILKINS, JERMAINE II
Entity Type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:
Last Name:WILKINS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 COAL PL SE APT 3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4455
Mailing Address - Country:US
Mailing Address - Phone:505-377-9384
Mailing Address - Fax:
Practice Address - Street 1:1710 COAL PL SE APT 3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4455
Practice Address - Country:US
Practice Address - Phone:505-377-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health