Provider Demographics
NPI:1417915513
Name:WHEELAHAN, JAMIE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:WHEELAHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 B GALE WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3552
Mailing Address - Country:US
Mailing Address - Phone:707-646-5300
Mailing Address - Fax:707-646-5334
Practice Address - Street 1:1200 B GALE WILSON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3552
Practice Address - Country:US
Practice Address - Phone:707-646-5300
Practice Address - Fax:707-646-5334
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17220363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17220OtherLICENSE
NE110636OtherLICENSE
NE47037658373Medicaid
NE47078557542Medicaid
NEQ22116Medicare UPIN
NE47037658373Medicaid