Provider Demographics
NPI:1174820658
Name:WHEELER, STACEY MICHELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MICHELLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:MICHELLE
Other - Last Name:BRAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:570 CRESTROSE CT
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-8615
Mailing Address - Country:US
Mailing Address - Phone:740-485-3511
Mailing Address - Fax:
Practice Address - Street 1:570 CRESTROSE CT
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:OH
Practice Address - Zip Code:43028-8615
Practice Address - Country:US
Practice Address - Phone:740-485-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse