Provider Demographics
NPI:1518794189
Name:WILKERSON, CASSY MARIE (RN)
Entity type:Individual
Prefix:
First Name:CASSY
Middle Name:MARIE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CASSY
Other - Middle Name:MARIE
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8462 N MEADOWSIDE CT
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3159
Mailing Address - Country:US
Mailing Address - Phone:414-937-1445
Mailing Address - Fax:
Practice Address - Street 1:1610 MILLER PARK WAY
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3604
Practice Address - Country:US
Practice Address - Phone:414-604-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI259710163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse