Provider Demographics
NPI:1396080024
Name:WILCOX, ROSE CAROLYN (ACNP)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:CAROLYN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1197 US HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:OH
Mailing Address - Zip Code:43517-9701
Mailing Address - Country:US
Mailing Address - Phone:604-457-0802
Mailing Address - Fax:
Practice Address - Street 1:14411 SMUGGLERS NOTCH
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-8701
Practice Address - Country:US
Practice Address - Phone:260-515-3275
Practice Address - Fax:888-803-6843
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004246A363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner