Provider Demographics
NPI:1851039549
Name:WILKERSON, ARETHA WYCHELLE
Entity type:Individual
Prefix:
First Name:ARETHA
Middle Name:WYCHELLE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12138 CENTRAL AVE # 223
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:202-983-2411
Mailing Address - Fax:
Practice Address - Street 1:10206 PRINCE PL APT 202
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1230
Practice Address - Country:US
Practice Address - Phone:202-983-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant