Provider Demographics
NPI:1881810489
Name:WILCOX, DIANA L (NP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9765 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-9084
Mailing Address - Country:US
Mailing Address - Phone:937-393-2593
Mailing Address - Fax:937-393-8253
Practice Address - Street 1:9765 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-9084
Practice Address - Country:US
Practice Address - Phone:937-393-2593
Practice Address - Fax:937-393-8253
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103000Medicaid
OH0103000Medicaid
OHH352280Medicare PIN