Provider Demographics
NPI:1760299762
Name:DAVILMAR, WILBERTE
Entity type:Individual
Prefix:
First Name:WILBERTE
Middle Name:
Last Name:DAVILMAR
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 1:1263 SAINT MARKS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2442
Mailing Address - Country:US
Mailing Address - Phone:786-387-0480
Mailing Address - Fax:
Practice Address - Street 1:1263 SAINT MARKS AVE # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2442
Practice Address - Country:US
Practice Address - Phone:786-387-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY681397-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse