Provider Demographics
NPI:1134161425
Name:WHEELER, CARL (CRNP)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-247-7500
Mailing Address - Fax:410-737-8424
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-247-7500
Practice Address - Fax:410-737-8424
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR106283363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409210400Medicaid
MD409210400Medicaid
MD149999YLJMedicare PIN