MEDICARE: CAMMIE WILCOX

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	163W00000X	Registered Nurse	RN642127	PA

General Provider Information

NPI Number	:	1942617972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMMIE WILCOX

Provider Business Mailing Address
First Line	:	1500 MARKET ST
Second Line	:	CENTRE SQUARE EAST
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2100
Country	:	US
Telephone Number	:	215-985-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5725 SPRAGUE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1721
Country	:	US
Telephone Number	:	215-438-3991
Fax Number	:

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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Directions to “ CAMMIE WILCOX ” Practice Location

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