Healthcare Provider Details

I. General information

NPI: 1336393040
Provider Name (Legal Business Name): WILENA HANKINS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 LANCER DR
PORTSMOUTH VA
23701-2149
US

IV. Provider business mailing address

682 LANCER DR
PORTSMOUTH VA
23701-2149
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-2187
  • Fax:
Mailing address:
  • Phone: 757-488-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401106639
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: