Provider Demographics
NPI:1821665134
Name:WILCOX, LINDA JEAN (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEAN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 NE 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEMAN
Mailing Address - State:IA
Mailing Address - Zip Code:50007-9724
Mailing Address - Country:US
Mailing Address - Phone:515-326-2580
Mailing Address - Fax:
Practice Address - Street 1:270 NE 141ST AVE
Practice Address - Street 2:
Practice Address - City:ALLEMAN
Practice Address - State:IA
Practice Address - Zip Code:50007-9724
Practice Address - Country:US
Practice Address - Phone:515-326-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered