Provider Demographics
NPI:1275660466
Name:WHEELDON, MARY ELIZABETH GERALDINE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:GERALDINE
Last Name:WHEELDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:WHEELDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:4401 N CAMPUS RIDGE DR
Mailing Address - Street 2:STE 2450
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6112
Mailing Address - Country:US
Mailing Address - Phone:989-839-1386
Mailing Address - Fax:989-839-3324
Practice Address - Street 1:4401 N CAMPUS RIDGE DR
Practice Address - Street 2:STE 2450
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6112
Practice Address - Country:US
Practice Address - Phone:989-839-1386
Practice Address - Fax:989-839-3324
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47024261842363LA2200X
CO69352163WG0600X
MI4704261842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275660466Medicaid
MI0P01150005Medicare PIN