Provider Demographics
NPI:1326392804
Name:WILCOX, NANETTE (LISW)
Entity Type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BUENA VISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4260
Mailing Address - Country:US
Mailing Address - Phone:505-823-8720
Mailing Address - Fax:
Practice Address - Street 1:2501 BUENA VISTA DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4260
Practice Address - Country:US
Practice Address - Phone:505-823-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-055281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical