Provider Demographics
NPI:1649560624
Name:WILKINSON, RODNEY B (LPN)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:B
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1102
Mailing Address - Country:US
Mailing Address - Phone:585-285-7148
Mailing Address - Fax:
Practice Address - Street 1:191 CLAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1102
Practice Address - Country:US
Practice Address - Phone:585-285-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291302-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse