Provider Demographics
NPI:1841577152
Name:WILCOX, ENEFAA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ENEFAA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BOSSI AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2002
Mailing Address - Country:US
Mailing Address - Phone:617-230-0787
Mailing Address - Fax:781-986-4627
Practice Address - Street 1:1200 BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-2337
Practice Address - Country:US
Practice Address - Phone:617-913-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094754AMedicaid
MA003078501Medicare PIN