MEDICARE: DUANE LEE WILCOX NP

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	363LF0000X	Family Nurse Practitioner	4704262470	MI

General Provider Information

NPI Number	:	1356836233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE LEE WILCOX NP

Provider Business Mailing Address
First Line	:	8708 N SHORE DR
Second Line	:
City	:	CLARKLAKE
State	:	MI
Zip	:	49234-9794
Country	:	US
Telephone Number	:	517-529-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	8708 N SHORE DR
Second Line	:
City	:	CLARKLAKE
State	:	MI
Zip	:	49234-9794
Country	:	US
Telephone Number	:	517-529-3151
Fax Number	:

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

Provider Enumeration Date	:	06/24/2018
Last Update Date	:	06/24/2018

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