Provider Demographics
NPI:1295547966
Name:WILKE, AMY MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:WILKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:KILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6813 JADE LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1717
Mailing Address - Country:US
Mailing Address - Phone:858-335-4708
Mailing Address - Fax:
Practice Address - Street 1:6813 JADE LN
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1717
Practice Address - Country:US
Practice Address - Phone:858-335-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA675894163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support