Provider Demographics
NPI:1609374248
Name:WILCOX, WILLIAM MAURICE (APRN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MAURICE
Last Name:WILCOX
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:MAURICE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:14 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1605
Mailing Address - Country:US
Mailing Address - Phone:603-236-6464
Mailing Address - Fax:
Practice Address - Street 1:96 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NH
Practice Address - Zip Code:03220-3045
Practice Address - Country:US
Practice Address - Phone:603-267-0656
Practice Address - Fax:603-267-0657
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044141-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH044141-23Medicaid