Provider Demographics
NPI:1639145402
Name:WILCOX, RACHEL A (RN CNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:WILCOX
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215
Mailing Address - Country:US
Mailing Address - Phone:320-843-2030
Mailing Address - Fax:320-314-1542
Practice Address - Street 1:1805 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215
Practice Address - Country:US
Practice Address - Phone:320-843-2030
Practice Address - Fax:320-314-1542
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0747282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN337483100Medicaid
MN337483100Medicaid
MN500000999Medicare ID - Type Unspecified