Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 252098 | MA |
NPI | 1023202397 |
---|---|
Provider Name | Ms. Emily J Wilcox |
First Address | Revere, MA 02151-3675 |
Second Address | Revere, MA 02151-3675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 30/08/2007 |