Provider Demographics
NPI:1669239349
Name:WILBUR, ALEXZANDRIA NICOLE
Entity type:Individual
Prefix:
First Name:ALEXZANDRIA
Middle Name:NICOLE
Last Name:WILBUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8746
Mailing Address - Country:US
Mailing Address - Phone:740-709-2699
Mailing Address - Fax:
Practice Address - Street 1:163 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8746
Practice Address - Country:US
Practice Address - Phone:740-709-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide