Provider Demographics
NPI:1518328392
Name:WILCOX, TARA (ND)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 CRESTON RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 CRESTON RD
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:MT
Practice Address - Zip Code:59901-8223
Practice Address - Country:US
Practice Address - Phone:406-672-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-LIC-NAT-1298175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath