Provider Demographics
NPI:1790796472
Name:WHEATLEY, ANNE W (CNM)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:W
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 S J ST
Mailing Address - Street 2:#120
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4964
Mailing Address - Country:US
Mailing Address - Phone:253-207-4890
Mailing Address - Fax:253-207-4871
Practice Address - Street 1:1812 S J ST
Practice Address - Street 2:#120
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4964
Practice Address - Country:US
Practice Address - Phone:253-207-4890
Practice Address - Fax:253-207-4871
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006588367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638628Medicaid
WA0176351OtherSTATE L&I
WA8931117OtherSTATE CRIME VICTIMS
WA8931117OtherSTATE CRIME VICTIMS
Q03039Medicare UPIN