Provider Demographics
NPI:1063090678
Name:WILKEN, BRENDA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WILKEN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 WEYDON RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3046
Mailing Address - Country:US
Mailing Address - Phone:614-581-6646
Mailing Address - Fax:
Practice Address - Street 1:241 WEYDON RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3046
Practice Address - Country:US
Practice Address - Phone:614-581-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date: