Provider Information for 1215412077
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SHANIA L WILKES
Sex: Female
NPI: 1215412077
Last Updated: 2018-09-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1215412077 | ||||||||
| Enumeration Date | 2018-09-27 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2201 E STATE ST HERMITAGE, PA 16148-2727 United States Phone: 866-853-7758 | Fax:727-981-7763 | ||||||||
| Primary Practice Address | 2201 E STATE ST HERMITAGE, PA 16148-2727 United States Phone: 866-853-7758 | Fax:727-981-7763 | ||||||||
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