Provider Demographics
NPI:1114185287
Name:WHEELER, MARY SUE (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UAH COLLEGE OF NURSING
Mailing Address - Street 2:NURSING BUILDING
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35899-0001
Mailing Address - Country:US
Mailing Address - Phone:703-608-2986
Mailing Address - Fax:
Practice Address - Street 1:UAH COLLEGE OF NURSING
Practice Address - Street 2:NURSING BUILDING
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35899-0001
Practice Address - Country:US
Practice Address - Phone:703-608-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001070766163W00000X
AL1-132507163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-132507OtherALABAMA BOARD OF NURSING
VA0001070766OtherLICENSE