MEDICARE: COREY-MICHAEL WILCOX FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CNP251322	ME
2	363LA2100X	Acute Care Nurse Practitioner	CNP251322	ME

General Provider Information

NPI Number	:	1730072711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY-MICHAEL WILCOX FNP

Provider Business Mailing Address
First Line	:	100 GANNETT DR STE C
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-5900
Country	:	US
Telephone Number	:	207-347-2947
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 FODEN RD STE 203
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2327
Country	:	US
Telephone Number	:	207-874-1489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	12/17/2025

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