Individual
WAYNE DOUGLAS WILKENS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1225 HARDING PL, STE 2100, CHARLOTTE, NC 28204-2826
(704) 331-9669
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5009412
NC
363LG0600X
Gerontology Nurse Practitioner
5009412
NC
Other
Enumeration date
06/23/2017
Last updated
07/15/2024
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