Provider Demographics
NPI:1538305883
Name:WHEELER, JENNY MAE (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MAE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-0014
Mailing Address - Country:US
Mailing Address - Phone:760-835-6277
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-0421
Practice Address - Country:US
Practice Address - Phone:760-835-6277
Practice Address - Fax:760-393-0522
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22786207Q00000X
CAA150173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty