Individual
MARY E WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDE
Contact information
Practice address
201 CEDAR SE, SUITE 4640, ALBUQUERQUE, NM 87106
(505) 536-6530
(505) 563-3625
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
R19788
NM
Other
Enumeration date
06/16/2010
Last updated
06/16/2010
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