Provider Demographics
NPI:1578903423
Name:WHEELER, AMBER LARUE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LARUE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:LARUE
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:7240 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4635
Mailing Address - Country:US
Mailing Address - Phone:410-733-2483
Mailing Address - Fax:
Practice Address - Street 1:2014 S TOLLGATE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5903
Practice Address - Country:US
Practice Address - Phone:410-569-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169571363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics