Provider Demographics
NPI:1508645151
Name:WHEELER, STACY NICOLE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:NICOLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9759
Mailing Address - Country:US
Mailing Address - Phone:614-743-4913
Mailing Address - Fax:
Practice Address - Street 1:12345 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-9759
Practice Address - Country:US
Practice Address - Phone:614-743-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily