Provider Demographics
NPI:1447723317
Name:WILCOX, DIMITRIUS M (RN)
Entity type:Individual
Prefix:
First Name:DIMITRIUS
Middle Name:M
Last Name:WILCOX
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 IVYHILL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4727
Mailing Address - Country:US
Mailing Address - Phone:513-551-9556
Mailing Address - Fax:
Practice Address - Street 1:DIMITRIUS WILCOX
Practice Address - Street 2:805 WOODLAWN AVE FL #2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205
Practice Address - Country:US
Practice Address - Phone:513-551-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.513531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse