Provider Demographics
NPI:1568979789
Name:WILCOX, LOUISE KAY
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:KAY
Last Name:WILCOX
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 1:8794 COUNTY ROAD 550
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9785
Mailing Address - Country:US
Mailing Address - Phone:906-235-0231
Mailing Address - Fax:
Practice Address - Street 1:8794 COUNTY ROAD 550
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9785
Practice Address - Country:US
Practice Address - Phone:906-235-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704101501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse