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NPI Code Detail

MEDICARE: JALINE WILKES

MEDICARE: JALINE WILKES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/CenterCOA.18835-NPOH
2363LF0000XFamily Nurse PractitionerAPRN.CNP.18835OH

General Provider Information

NPI Number : 1093175101
Entity Type Code : Individual
Provider Name (Legal Business Name) : JALINE WILKES
Provider Business Mailing Address
First Line : 13944 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3804
Country : US
Telephone Number : 216-767-4292
Fax Number : 216-767-4274
Provider Business Practice Location Address
First Line : 13944 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3804
Country : US
Telephone Number : 216-767-4292
Fax Number : 216-767-4274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2016
Last Update Date : 11/05/2019

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