Healthcare Provider Details

I. General information

NPI: 1871458521
Provider Name (Legal Business Name): GABRIELLE BENEDETTA WILKING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 HURON ST
NORTH BRANCH MI
48461-8667
US

IV. Provider business mailing address

136 MINOT ST
ROMEO MI
48065-4627
US

V. Phone/Fax

Practice location:
  • Phone: 810-688-3093
  • Fax: 810-688-3694
Mailing address:
  • Phone: 586-551-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013689
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: