Wilcoxen, Randall Lane

Wilcoxen, Randall Lane is an individual health care provider with primary practice located at 5114 N Glen Park Place Rd , Peoria IL 61614-4686. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Wilcoxen, Randall Lane can be contacted via phone (309) 683-2402.

Contact Information

Primary practice address
5114 N Glen Park Place Rd Peoria IL 61614-4686
Phone: (309) 683-2402
Fax: (309) 683-2419
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085000632 Illinois

Profile Details

NPI number 1851363022
LBN Legal business name Wilcoxen, Randall Lane
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2006
Last updated Jan 23rd, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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