Provider Demographics
NPI:1770230989
Name:WILCOXSON, ANDREA RAE (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RAE
Last Name:WILCOXSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 S JACKSON GAP CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2465
Mailing Address - Country:US
Mailing Address - Phone:719-406-3237
Mailing Address - Fax:
Practice Address - Street 1:6313 S JACKSON GAP CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2465
Practice Address - Country:US
Practice Address - Phone:719-406-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0176166163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency