Provider Demographics
NPI:1609841147
Name:WILCOX, JANINE M A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:M A
Last Name:WILCOX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 STONEPOST RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4172
Mailing Address - Country:US
Mailing Address - Phone:860-633-7470
Mailing Address - Fax:
Practice Address - Street 1:30 HYDE AVE STE 109
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4503
Practice Address - Country:US
Practice Address - Phone:860-454-0303
Practice Address - Fax:860-875-4242
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000821363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235744Medicaid
CTP95334Medicare UPIN
CT004235744Medicaid