Individual
MARTHA WILCOXEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
360 DEPOT RD, KEATCHIE, LA 71046-5202
(318) 464-5544
Mailing address
360 DEPOT RD, KEATCHIE, LA 71046-5202
(318) 464-5554
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
003272358
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003272358
HEALTH CARE TECHNICIAN
LA
Enumeration date
09/24/2019
Last updated
09/24/2019
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