Provider Demographics
NPI:1003877275
Name:WHEELER, LISA (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WHEELER
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Gender:F
Credentials:PA
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Mailing Address - Street 1:840 FLEMING ST
Mailing Address - Street 2:STE 1
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3541
Mailing Address - Country:US
Mailing Address - Phone:828-490-4444
Mailing Address - Fax:828-698-7077
Practice Address - Street 1:840 FLEMING ST
Practice Address - Street 2:STE 1
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3541
Practice Address - Country:US
Practice Address - Phone:828-490-4444
Practice Address - Fax:828-698-7077
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-01-26
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Provider Licenses
StateLicense IDTaxonomies
NC101808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2755151Medicare PIN
NC970019904Medicare PIN
NCR94152Medicare UPIN