Provider Demographics
NPI:1831677442
Name:WILCOX, LISA CAROL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:WILCOX
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15035 HAMILTON POOL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7618
Mailing Address - Country:US
Mailing Address - Phone:512-461-9968
Mailing Address - Fax:
Practice Address - Street 1:15035 HAMILTON POOL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-7618
Practice Address - Country:US
Practice Address - Phone:512-461-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse