Provider Demographics
NPI:1124193537
Name:WHEELER, TAMMY LEE (APRN-RX)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LEE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 MAKANI CIR
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3444
Mailing Address - Country:US
Mailing Address - Phone:808-959-3513
Mailing Address - Fax:
Practice Address - Street 1:37 KEKAULIKE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2462
Practice Address - Country:US
Practice Address - Phone:808-959-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI139363LA2200X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56716701OtherALOHA CARE
GU0000567167Medicare ID - Type Unspecified