Provider Demographics
NPI:1124373121
Name:WILHELM, DARLENE MARIE (CNP)
Entity type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:MARIE
Last Name:WILHELM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:GOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:
Practice Address - Street 1:2702 NAVARRE AVE STE 320
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3224
Practice Address - Country:US
Practice Address - Phone:419-696-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13526NP207RG0100X
OHAPRN.CNP.13526363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology