MEDICARE: MS. CHANDRA WILKINS

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
1	172A00000X	Driver

General Provider Information

NPI Number	:	1154095099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANDRA WILKINS

Provider Business Mailing Address
First Line	:	4508 FORDHAM RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1122
Country	:	US
Telephone Number	:	804-244-4920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4508 FORDHAM RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1122
Country	:	US
Telephone Number	:	804-244-4920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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