Provider Demographics
NPI:1013955863
Name:WHEELER, WENDY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 SOUTH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-6252
Mailing Address - Country:US
Mailing Address - Phone:978-729-3456
Mailing Address - Fax:978-456-9130
Practice Address - Street 1:881 SOUTH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-6252
Practice Address - Country:US
Practice Address - Phone:978-729-3456
Practice Address - Fax:978-456-9130
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135494163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0413Medicare ID - Type UnspecifiedMEDICARE BILLING ID