MEDICARE: BRANDI DANIELLE WILKERSON RN

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	0001277263	VA

General Provider Information

NPI Number	:	1861081309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI DANIELLE WILKERSON RN

Provider Business Mailing Address
First Line	:	607 LENTEN ROSE LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 LENTEN ROSE LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5862
Country	:	US
Telephone Number	:	804-921-1640
Fax Number	:

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

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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