Provider Demographics
NPI:1821987512
Name:WILSON, ROXANE RAE
Entity type:Individual
Prefix:
First Name:ROXANE
Middle Name:RAE
Last Name:WILSON
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 1:406 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68785-2630
Mailing Address - Country:US
Mailing Address - Phone:712-212-4140
Mailing Address - Fax:
Practice Address - Street 1:406 3RD ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:NE
Practice Address - Zip Code:68785-2630
Practice Address - Country:US
Practice Address - Phone:712-212-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker