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NPI Code Detail

MEDICARE: KAREN S WILKINSON MS,RD,LD,CD

MEDICARE: KAREN S WILKINSON MS,RD,LD,CD
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
1133V00000XRegistered DietitianLD 2341OH

General Provider Information

NPI Number : 1275569295
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN S WILKINSON MS,RD,LD,CD
Provider Business Mailing Address
First Line : 4210 FLAGSTAFF CV
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4417
Country : US
Telephone Number : 260-489-9009
Fax Number : 260-489-5057
Provider Business Practice Location Address
First Line : 4210 FLAGSTAFF CV
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4417
Country : US
Telephone Number : 260-489-9009
Fax Number : 260-489-5057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/08/2007

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