Provider Demographics
NPI:1205608445
Name:WILKENS, JESSICA D (RN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:D
Last Name:WILKENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:BRUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3251 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5399
Mailing Address - Country:US
Mailing Address - Phone:319-234-2893
Mailing Address - Fax:319-234-0354
Practice Address - Street 1:3251 W 9TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5399
Practice Address - Country:US
Practice Address - Phone:319-234-2893
Practice Address - Fax:319-234-0354
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA144588163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health