Provider Demographics
NPI:1962712422
Name:WILKERSON, RONALD L JR (RN)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:WILKERSON
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6194 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3611
Mailing Address - Country:US
Mailing Address - Phone:414-213-8000
Mailing Address - Fax:414-357-6861
Practice Address - Street 1:4019 N 87TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1708
Practice Address - Country:US
Practice Address - Phone:414-745-3053
Practice Address - Fax:414-357-6861
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI145967-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse