Provider Demographics
NPI:1679851547
Name:WHEELER, LAUREN MOYER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MOYER
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3706 KENNETT PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2157
Mailing Address - Country:US
Mailing Address - Phone:302-623-6320
Mailing Address - Fax:302-421-5200
Practice Address - Street 1:3506 KENNETT PIKE STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-3019
Practice Address - Country:US
Practice Address - Phone:302-661-3375
Practice Address - Fax:302-661-3374
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0000774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant