Provider Demographics
NPI:1578219788
Name:WILKINSON, DEANNA IRENE
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:IRENE
Last Name:WILKINSON
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 1:11456 CANBY CT
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-2683
Mailing Address - Country:US
Mailing Address - Phone:616-485-4348
Mailing Address - Fax:
Practice Address - Street 1:11456 CANBY CT
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-2683
Practice Address - Country:US
Practice Address - Phone:616-485-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
OH31-016388124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No171400000XOther Service ProvidersHealth & Wellness Coach