Provider Demographics
NPI:1265871446
Name:WHEATLEY, MARY THERESA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1137
Mailing Address - Country:US
Mailing Address - Phone:240-424-3668
Mailing Address - Fax:
Practice Address - Street 1:5015 SOMERSET RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE PARK
Practice Address - State:MD
Practice Address - Zip Code:20737-1137
Practice Address - Country:US
Practice Address - Phone:240-424-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula