Provider Demographics
NPI:1992012249
Name:WILKERSON, WENDY MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11326 VAIL CUT OFF RD SE
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-9604
Mailing Address - Country:US
Mailing Address - Phone:360-446-2270
Mailing Address - Fax:
Practice Address - Street 1:11326 VAIL CUT OFF RD SE
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:WA
Practice Address - Zip Code:98576-9604
Practice Address - Country:US
Practice Address - Phone:360-446-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00056453164W00000X
TX194801164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse