Provider Demographics
NPI:1457053027
Name:WHEELER, LATHACA DENISE (DOULA)
Entity Type:Individual
Prefix:
First Name:LATHACA
Middle Name:DENISE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 STONEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1226
Mailing Address - Country:US
Mailing Address - Phone:229-319-3268
Mailing Address - Fax:
Practice Address - Street 1:4913 STONEBROOKE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1226
Practice Address - Country:US
Practice Address - Phone:229-319-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula