Provider Demographics
NPI:1013070127
Name:WHEELER, JENETTE HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:JENETTE
Middle Name:HARVEY
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LLANFAIR RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2501
Mailing Address - Country:US
Mailing Address - Phone:610-896-7210
Mailing Address - Fax:
Practice Address - Street 1:399 S 34TH ST
Practice Address - Street 2:UNIVERSITY OF PENNSYLVANIA STUDENT HEALTH SERVICE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4316
Practice Address - Country:US
Practice Address - Phone:215-662-2859
Practice Address - Fax:215-349-5797
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 012432E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine