MEDICARE: DARLENE SMITH WILKEY CNP

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	363LF0000X	Family Nurse Practitioner	R1417935	MN

General Provider Information

NPI Number	:	1700986577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE SMITH WILKEY CNP

Provider Business Mailing Address
First Line	:	2723 MINNESOTA AVE NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-2223
Country	:	US
Telephone Number	:	218-751-2517
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 5TH ST NW
Second Line	:	SUITE D
City	:	BEMIDJI
State	:	MN
Zip	:	56601-2932
Country	:	US
Telephone Number	:	218-444-7186
Fax Number	:	218-444-2460

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/19/2012

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