Provider Demographics
NPI:1508603648
Name:WHEELOCK, CHRISTOPHER ALLAN (RN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLAN
Last Name:WHEELOCK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:WHEELOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1010 RIVER HAVEN CIR APT D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4121
Mailing Address - Country:US
Mailing Address - Phone:208-640-3236
Mailing Address - Fax:
Practice Address - Street 1:151B RUTLEDGE AVE # MSC962
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8903
Practice Address - Country:US
Practice Address - Phone:843-792-7016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11303028-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse