1679548630 NPI number — MRS. DARLENE WHITAKER WILKINS MED RN, CDE

Table of content: MRS. DARLENE WHITAKER WILKINS MED RN, CDE (NPI 1679548630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679548630 NPI number — MRS. DARLENE WHITAKER WILKINS MED RN, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINS
Provider First Name:
DARLENE
Provider Middle Name:
WHITAKER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED RN, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITAKER
Provider Other First Name:
LUCY
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679548630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4020 WAKE FOREST RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-6866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-571-6465
Provider Business Mailing Address Fax Number:
919-571-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4020 WAKE FOREST RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-6866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-571-6465
Provider Business Practice Location Address Fax Number:
919-571-6455
Provider Enumeration Date:
02/22/2006

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: 163W00000X , with the licence number:  051395 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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