Provider Demographics
NPI:1659069417
Name:WHEELER, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 E KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3223
Mailing Address - Country:US
Mailing Address - Phone:717-394-8908
Mailing Address - Fax:717-207-0400
Practice Address - Street 1:955 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3223
Practice Address - Country:US
Practice Address - Phone:717-394-8908
Practice Address - Fax:717-207-0400
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant