Healthcare Provider Details

I. General information

NPI: 1902118938
Provider Name (Legal Business Name): LINDSEY MARIE WILKENING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 S GOODRICH ST
COLFAX IA
50054-1753
US

IV. Provider business mailing address

588 S GOODRICH ST
COLFAX IA
50054-1753
US

V. Phone/Fax

Practice location:
  • Phone: 515-423-7075
  • Fax:
Mailing address:
  • Phone: 515-423-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number232448
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: