Provider Demographics
NPI:1598903486
Name:WILKES-WOOTEN, ANTOINETTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:WILKES-WOOTEN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75TH MC (AS)
Mailing Address - Street 2:UNIT #15190, BOX 81
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:301-574-0979
Mailing Address - Fax:315-753-8112
Practice Address - Street 1:4604 HALLORAN CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6122
Practice Address - Country:US
Practice Address - Phone:301-574-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC177200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse