Healthcare Provider Details

I. General information

NPI: 1124895164
Provider Name (Legal Business Name): ISABELLE WILCOX FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W FOOTHILL BLVD
UPLAND CA
91786-3855
US

IV. Provider business mailing address

6021 LILY ROCK DR
FONTANA CA
92336-4575
US

V. Phone/Fax

Practice location:
  • Phone: 909-435-4707
  • Fax: 909-415-9123
Mailing address:
  • Phone: 909-627-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: