MEDICARE: BRENDA 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
1	163W00000X	Registered Nurse	494846	NY
2	363LP2300X	Primary Care Nurse Practitioner	312648	NY

General Provider Information

NPI Number	:	1437763190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA WILKES

Provider Business Mailing Address
First Line	:	442 LORIMER ST
Second Line	:	STD PMB 5025
City	:	BROOKLYN
State	:	NY
Zip	:	11206-1030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 LORIMER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-1030
Country	:	US
Telephone Number	:	516-939-4945
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	02/12/2026

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