Provider Demographics
NPI:1881208734
Name:WILCOX, CHANTEL (MBA)
Entity Type:Individual
Prefix:MISS
First Name:CHANTEL
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 CENTER ST APT 404
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2352
Mailing Address - Country:US
Mailing Address - Phone:216-402-4089
Mailing Address - Fax:
Practice Address - Street 1:2018 CENTER ST APT 404
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2352
Practice Address - Country:US
Practice Address - Phone:216-402-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker