Provider Demographics
NPI:1235819475
Name:WHEELER, ELISE LOUISE (PCD, BCD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:LOUISE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PCD, BCD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:LOUISE
Other - Last Name:SILVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCD, BCD
Mailing Address - Street 1:6422 193RD ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5115
Mailing Address - Country:US
Mailing Address - Phone:919-438-2975
Mailing Address - Fax:
Practice Address - Street 1:7372 BERKSHIRE DOWNS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5636
Practice Address - Country:US
Practice Address - Phone:919-438-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174N00000XOther Service ProvidersLactation Consultant, Non-RN