Provider Demographics
NPI:1679751499
Name:WILCOXON, TAWANA CHARLET
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:CHARLET
Last Name:WILCOXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 HIGHWAY 6 N
Mailing Address - Street 2:APT# 136
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2323
Mailing Address - Country:US
Mailing Address - Phone:832-782-0031
Mailing Address - Fax:
Practice Address - Street 1:9125 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2323
Practice Address - Country:US
Practice Address - Phone:832-782-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion