1730260621 NPI number — LAUREN M WILKES PT

Table of content: LAUREN M WILKES PT (NPI 1730260621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730260621 NPI number — LAUREN M WILKES PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKES
Provider First Name:
LAUREN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNAMEE
Provider Other First Name:
LAUREN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730260621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 MACDADE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILMONT PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19033-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-583-1133
Provider Business Mailing Address Fax Number:
610-583-0855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 MACDADE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILMONT PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19033-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-583-1133
Provider Business Practice Location Address Fax Number:
610-583-0855
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  J10002002 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT017756 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)