Provider Demographics
NPI:1174829824
Name:WILCOXSON, JOLENE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:WILCOXSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 SW PARK SOUTH CT APT 307
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66609-2107
Mailing Address - Country:US
Mailing Address - Phone:785-383-4152
Mailing Address - Fax:
Practice Address - Street 1:5301 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2371
Practice Address - Country:US
Practice Address - Phone:785-273-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker