Healthcare Provider Details

I. General information

NPI: 1316290448
Provider Name (Legal Business Name): RACHEL NOLENE WANZOR-BOX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

PO BOX 5980
LUBBOCK TX
79408-5980
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0878
  • Fax:
Mailing address:
  • Phone: 806-761-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberCNP-02072
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP122711
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: