Provider Demographics
NPI:1841662624
Name:WILKERSON, TANGANYIKA
Entity type:Individual
Prefix:
First Name:TANGANYIKA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2726
Mailing Address - Country:US
Mailing Address - Phone:313-404-8231
Mailing Address - Fax:734-720-9087
Practice Address - Street 1:4961 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2726
Practice Address - Country:US
Practice Address - Phone:313-404-8231
Practice Address - Fax:734-720-9087
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care