Provider Demographics
NPI:1285049965
Name:WILCOX, PETER G (ARNP)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:WILCOX
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 NW MYHRE PL
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8561
Mailing Address - Country:US
Mailing Address - Phone:360-830-1600
Mailing Address - Fax:253-759-4699
Practice Address - Street 1:2011 NW MYHRE PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8561
Practice Address - Country:US
Practice Address - Phone:360-830-1600
Practice Address - Fax:253-759-4699
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60470374363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038792Medicaid