Provider Demographics
NPI:1437988417
Name:WILCOXSON, AALIYAH DESTINY
Entity type:Individual
Prefix:
First Name:AALIYAH
Middle Name:DESTINY
Last Name:WILCOXSON
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 1:18660 FITZPATRICK CT
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1430
Mailing Address - Country:US
Mailing Address - Phone:404-863-3921
Mailing Address - Fax:
Practice Address - Street 1:20800 WYOMING ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2163
Practice Address - Country:US
Practice Address - Phone:404-863-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide