Healthcare Provider Details

I. General information

NPI: 1578219788
Provider Name (Legal Business Name): DEANNA IRENE WILKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11456 CANBY CT
PLAIN CITY OH
43064-2683
US

IV. Provider business mailing address

11456 CANBY CT
PLAIN CITY OH
43064-2683
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-4348
  • Fax:
Mailing address:
  • Phone: 616-485-4348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31-016388
License Number StateOH

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: