Individual
KIMBERLY J WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3500
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
148836
WI
367500000X
Certified Registered Nurse Anesthetist
072750
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44339100
—
WI
Enumeration date
07/12/2007
Last updated
03/30/2022
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