Provider Demographics
NPI:1619869807
Name:WILKIE, JACQUELINE J
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:WILKIE
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 1:425 BURDICK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2663
Mailing Address - Country:US
Mailing Address - Phone:701-213-3750
Mailing Address - Fax:
Practice Address - Street 1:824 S 25TH ST APT 5
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-8613
Practice Address - Country:US
Practice Address - Phone:701-213-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDWIL8641803747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant