Provider Demographics
NPI:1790442358
Name:WHEELER, MATTHEW LANCE
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LANCE
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 FLAGSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7042
Mailing Address - Country:US
Mailing Address - Phone:858-386-9823
Mailing Address - Fax:
Practice Address - Street 1:132 FLAGSTONE WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7042
Practice Address - Country:US
Practice Address - Phone:858-386-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider