Provider Demographics
NPI:1124659362
Name:WILKERSON, CRAIG M
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12219 SWEETWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1435
Mailing Address - Country:US
Mailing Address - Phone:202-812-7484
Mailing Address - Fax:
Practice Address - Street 1:1310 GALLATIN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6918
Practice Address - Country:US
Practice Address - Phone:202-812-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant