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General NPI Number Information
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NPI Number | 1396080024
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Entity Type | Individual
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Provider Name | ROSE CAROLYN WILCOX A.C.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 14411 SMUGGLERS NOTCH SUITE A
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City | FORT WAYNE
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State | IN
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Zip | 46814-8701
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Country | US
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Telephone | 260-515-3275
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Fax | 888-803-6843
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Provider Business Mailing Address
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Address Line | 1197 US HIGHWAY 6
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City | EDGERTON
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State | OH
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Zip | 43517-9701
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Country | US
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Telephone | 604-457-0802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 71004246A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71004246A
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License Number State | IN
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