Provider Demographics
NPI:1740746437
Name:WILKIN, INEKE (RD)
Entity Type:Individual
Prefix:
First Name:INEKE
Middle Name:
Last Name:WILKIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111B HENRY CIR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-1427
Mailing Address - Country:US
Mailing Address - Phone:203-219-6137
Mailing Address - Fax:
Practice Address - Street 1:111B HENRY CIR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85613-1427
Practice Address - Country:US
Practice Address - Phone:203-219-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered