Provider Demographics
NPI:1669023883
Name:WILKERSON, CHRISTINE NAKABIRYE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NAKABIRYE
Last Name:WILKERSON
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 1:18 CLOVELLY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1238
Mailing Address - Country:US
Mailing Address - Phone:617-755-4544
Mailing Address - Fax:
Practice Address - Street 1:18 CLOVELLY RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1238
Practice Address - Country:US
Practice Address - Phone:617-755-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2324516163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty