Provider Demographics
NPI:1275376766
Name:MCLAURIN, WILHELMENIA (MED)
Entity type:Individual
Prefix:
First Name:WILHELMENIA
Middle Name:
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 N MACARTHUR BLVD APT 1195
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-6152
Mailing Address - Country:US
Mailing Address - Phone:601-918-2588
Mailing Address - Fax:
Practice Address - Street 1:8045 N MACARTHUR BLVD APT 1195
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-6152
Practice Address - Country:US
Practice Address - Phone:601-918-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85-0735661Medicaid