Provider Demographics
NPI:1902118938
Name:WILKENING, LINDSEY MARIE
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:WILKENING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 S GOODRICH ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054-1753
Mailing Address - Country:US
Mailing Address - Phone:515-423-7075
Mailing Address - Fax:
Practice Address - Street 1:588 S GOODRICH ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IA
Practice Address - Zip Code:50054-1753
Practice Address - Country:US
Practice Address - Phone:515-423-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA232448390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program