Provider Demographics
NPI:1083221147
Name:NORTHWILCOX, SONYA L (LPN)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:L
Last Name:NORTHWILCOX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 BURKEGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-6701
Mailing Address - Country:US
Mailing Address - Phone:346-279-4741
Mailing Address - Fax:
Practice Address - Street 1:3202 FIDELITY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-4264
Practice Address - Country:US
Practice Address - Phone:346-279-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216243164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse