Provider Demographics
NPI:1518441906
Name:WHEELER, DARLENE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LYNN ST APT 217
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1500
Mailing Address - Country:US
Mailing Address - Phone:914-565-0363
Mailing Address - Fax:434-857-5579
Practice Address - Street 1:614 LYNN ST APT 217
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1500
Practice Address - Country:US
Practice Address - Phone:914-565-0363
Practice Address - Fax:434-857-5579
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA908745390200000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA83-1946980Medicaid