Provider Demographics
NPI:1760654842
Name:WILCOX, JULIE ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:WNUK(MAIDEN) & TRZEBIATOWSKI(DIVOR.
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1731 DUBLIN TRAIL, APT. 77
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956
Mailing Address - Country:US
Mailing Address - Phone:920-558-4557
Mailing Address - Fax:
Practice Address - Street 1:425 PINE RIDGE BLVD.
Practice Address - Street 2:SUITE 211
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-845-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI046265367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered