Provider Demographics
NPI:1184404949
Name:WILKE, RICHARD BENJAMIN (ND)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BENJAMIN
Last Name:WILKE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:WILKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:3804 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6690
Mailing Address - Country:US
Mailing Address - Phone:802-985-8250
Mailing Address - Fax:
Practice Address - Street 1:3804 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6690
Practice Address - Country:US
Practice Address - Phone:802-985-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134223175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath