Provider Demographics
NPI:1588226823
Name:WHEELER, ADULT HEALTH NP, PLLC
Entity Type:Organization
Organization Name:WHEELER, ADULT HEALTH NP, PLLC
Other - Org Name:INNOVATIVE CARE AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHEELER
Authorized Official - Middle Name:ADULT
Authorized Official - Last Name:HEALTH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-217-4321
Mailing Address - Street 1:2 RUNNING BROOK DRIVE
Mailing Address - Street 2:2 RUNNING BROOK DRIVE
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-864-6316
Mailing Address - Fax:
Practice Address - Street 1:3024 NIAGARA FALLS BLVD STE 116
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1116
Practice Address - Country:US
Practice Address - Phone:716-217-4321
Practice Address - Fax:716-219-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty