Provider Demographics
NPI:1093952418
Name:WHEELER, SUSANNE CLARE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:CLARE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4010
Mailing Address - Country:US
Mailing Address - Phone:812-242-3005
Mailing Address - Fax:
Practice Address - Street 1:1725 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4010
Practice Address - Country:US
Practice Address - Phone:812-242-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28093785A363LP2300X
IN71002954A364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN192770C5Medicare PIN
IN859910F4Medicare PIN
IN265130A1Medicare PIN