Provider Demographics
NPI:1538759188
Name:WILCOX, JAHALA OLEMA (LVN)
Entity type:Individual
Prefix:MISS
First Name:JAHALA
Middle Name:OLEMA
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 DE SOTO AVE APT 36202
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-0218
Mailing Address - Country:US
Mailing Address - Phone:181-861-4677
Mailing Address - Fax:
Practice Address - Street 1:6200 DE SOTO AVE APT 36202
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-0218
Practice Address - Country:US
Practice Address - Phone:181-861-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN254061164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse