Provider Demographics
NPI:1043028020
Name:WILTURNER, DEAYA S
Entity type:Individual
Prefix:
First Name:DEAYA
Middle Name:S
Last Name:WILTURNER
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 1:777 N JEFFERSON ST STE 408
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3713
Mailing Address - Country:US
Mailing Address - Phone:414-308-8206
Mailing Address - Fax:
Practice Address - Street 1:3603 N 20TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1805
Practice Address - Country:US
Practice Address - Phone:414-308-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide