Individual
COREY-MICHAEL WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
100 FODEN RD STE 203, SOUTH PORTLAND, ME 04106-2327
(207) 874-1489
Mailing address
100 GANNETT DR STE C, SOUTH PORTLAND, ME 04106-5900
(207) 347-2947
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
CNP251322
ME
363LF0000X
Family Nurse Practitioner
Primary
CNP251322
ME
Other
Enumeration date
05/30/2025
Last updated
12/17/2025
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