Provider Demographics
NPI:1558347773
Name:WHEELER, ERIN L (RNCFNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RNCFNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:L
Other - Last Name:MALLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNCFNP
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4038
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3452
Practice Address - Country:US
Practice Address - Phone:319-524-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO127510008Medicare PIN