Provider Demographics
NPI:1689095242
Name:WILCOX, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
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 1:8150 STATE ROUTE 42
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064
Mailing Address - Country:US
Mailing Address - Phone:614-873-1696
Mailing Address - Fax:
Practice Address - Street 1:8150 STATE ROUTE 42
Practice Address - Street 2:SUITE B
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064
Practice Address - Country:US
Practice Address - Phone:614-873-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH389443163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health