DR. JEANNETTE LOUISE WILCOX (NPI# 1649275777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649275777 |
| Entity Type | Individual |
| Full Name | DR. JEANNETTE LOUISE WILCOX |
| Credential | MD |
| Practice Address |
14500 99th Ave N Maple Grove MN 55369-4730 |
| Mailing Address |
Fairview Clinic- Maple Grove 14500 99th Ave N Maple Grove MN 55369-4545 |
| Practice Telephone | (763) 898-1000 |
| Mailing Telephone | (763) 898-1000 |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
62034 | MN | Allopathic & Osteopathic Physicians |
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
15392 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 153924 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 65 International Dr, Greenville, SC 296154816 | 8649877000 | 8649877020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225278112 | Jeannette Elise Wilcox | Massage Therapist | 79440 Highway 111, Suite 104, La Quinta, CA 92253-4500 | 2009-03-04 |
| Street Address |
14500 99TH AVE N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215487525 | Wendy Blue | Registered Nurse | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2016-10-11 |
| 1942667209 | Rachel Leigh Lahti | Physician Assistant | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2016-01-18 |
| 1033585914 | Michaela Monetti | Psychologist | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2015-08-14 |
| 1922486109 | Charmi Shah | Internal Medicine | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2015-05-08 |
| 1356748495 | Nitika Ghattaura | Internal Medicine | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2014-12-03 |
| 1235571191 | Hanaa Tahir | Physician Assistant | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2013-07-20 |
| 1003255472 | Sarah Nicole Olson Venning | Counselor | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2013-06-19 |
| 1275970402 | Sarah A Wernimont | Obstetrics & Gynecology | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2013-05-29 |
| 1346582558 | Bethany Ann Sabol | Obstetrics & Gynecology | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2013-03-26 |
| 1003161787 | Heather Lage | Registered Nurse | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2012-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669031423 | Kai Jiang | Radiology | 617 4th St Sw Apt 3, Rochester, MN 55902-3286 | 2019-06-06 |
| 1508205311 | Somu Suppiah | Radiology | 6500 Excelsior Blvd Dept Of, St Louis Park, MN 55426 | 2013-06-14 |
| 1063858769 | Sumit Sean Sood | Radiology | 5160 Fairview Blvd Ste 1100, Wyoming, MN 55092-8050 | 2013-05-21 |
| 1831535863 | Megan Gentry Hodges | Radiology | 1900 Centracare Circle #1600, Centracare Clinic Health Plaza Radiology/oncology, St Cloud, MN 56303-5000 | 2013-05-16 |
| 1679838403 | Richard Lee | Radiology | 701 Park Ave # G1, Minneapolis, MN 55415-1623 | 2012-07-09 |
| 1396909404 | James Lee Ecker | Radiology | 10448 Vera Cruz Dr N, Brooklyn Park, MN 55443-2555 | 2008-07-17 |
| 1275627820 | Xin Wang | Radiology | The Center for Prostate Cancer, 420 Delaware Street Se, Mayo Building, Fourth Floor, Minneapolis, MN 55455 | 2006-10-03 |
| 1295759009 | Gregory Evan Meyers | Radiology | 6950 France Ave S Ste 200, Edina, MN 55435-2025 | 2006-07-26 |
| 1770526188 | Nathan Earl Hilton | Radiology | 215 Ivy St, Brainerd, MN 56401-3000 | 2006-06-14 |
| 1124082136 | Janel A Cox | Radiology | 631 Goodrich Ave, Saint Paul, MN 55105-3522 | 2006-04-14 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.