MEDICARE: DONNA CATHERINE WILCOX PAC

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	363AM0700X	Medical Physician Assistant	PA13092	CA

General Provider Information

NPI Number	:	1023102530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA CATHERINE WILCOX PAC

Provider Business Mailing Address
First Line	:	3829 N HWY 3
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-9524
Country	:	US
Telephone Number	:	707-268-8502
Fax Number	:

Provider Business Practice Location Address
First Line	:	3829 N HWY 3
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-9524
Country	:	US
Telephone Number	:	707-268-8502
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/02/2014

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Directions to “ DONNA CATHERINE WILCOX PAC” Practice Location

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