Provider Demographics
NPI:1689904518
Name:WHEELER, JOHNNIE VADRON (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:VADRON
Last Name:WHEELER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 W BOTTSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3325
Mailing Address - Country:US
Mailing Address - Phone:773-668-9715
Mailing Address - Fax:
Practice Address - Street 1:7825 W BOTTSFORD AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3325
Practice Address - Country:US
Practice Address - Phone:773-668-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311671-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse