Provider Demographics
NPI:1689725376
Name:CORLEY-WHEELER, NANCY (MN ARNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:CORLEY-WHEELER
Suffix:
Gender:F
Credentials:MN ARNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:CORLEY-WHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:608 S G ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4625
Mailing Address - Country:US
Mailing Address - Phone:253-573-1105
Mailing Address - Fax:253-573-1104
Practice Address - Street 1:608 S G STREET
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4625
Practice Address - Country:US
Practice Address - Phone:253-573-1105
Practice Address - Fax:253-573-1104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9646704Medicaid
WAAP30001770OtherARNP
8858955Medicare ID - Type Unspecified
WAAP30001770OtherARNP