Individual
MANDI NICOLE WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, RN
Contact information
Practice address
2811 TIETON DR, YAKIMA, WA 98902-3761
(509) 575-8100
Mailing address
PO BOX 335, NACHES, WA 98937-0335
(509) 388-8074
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60435024
WA
363L00000X
Nurse Practitioner
Primary
AP61104820
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN60435024
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
09/09/2020
Last updated
11/05/2020
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