Provider Demographics
NPI:1073342143
Name:WILKERSON, MICHELLE (BSN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 S TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5448
Mailing Address - Country:US
Mailing Address - Phone:970-252-7062
Mailing Address - Fax:970-964-2492
Practice Address - Street 1:1845 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5448
Practice Address - Country:US
Practice Address - Phone:970-252-7062
Practice Address - Fax:970-964-2492
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN1680243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse