Provider Demographics
NPI:1942961107
Name:WHEELER, CLARISSA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:MRS
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIR LOSS SPECIALIST
Mailing Address - Street 1:165 HAGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35150
Mailing Address - Country:US
Mailing Address - Phone:256-404-2096
Mailing Address - Fax:
Practice Address - Street 1:165 HAGAN AVE
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044
Practice Address - Country:US
Practice Address - Phone:256-404-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management