Healthcare Provider Details

I. General information

NPI: 1568486637
Provider Name (Legal Business Name): EVELYN J WILCOX C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17720 SE MILL PLAIN BLVD
VANCOUVER WA
98683-7583
US

IV. Provider business mailing address

1111 ARCHWOOD DR SW UNIT 382
OLYMPIA WA
98502-5606
US

V. Phone/Fax

Practice location:
  • Phone: 360-823-2020
  • Fax:
Mailing address:
  • Phone: 956-266-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number695141
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: