Provider Demographics
NPI:1598882516
Name:WILCOX, LAWRENCE J (NP)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:WILCOX
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 CABLE RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-9758
Mailing Address - Country:US
Mailing Address - Phone:716-672-8595
Mailing Address - Fax:
Practice Address - Street 1:9300 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:BROCTON
Practice Address - State:NY
Practice Address - Zip Code:14716
Practice Address - Country:US
Practice Address - Phone:716-792-7100
Practice Address - Fax:716-792-7100
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-08-21
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-21
Provider Licenses
StateLicense IDTaxonomies
NYF333136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily