Provider Demographics
NPI:1659110807
Name:WHEATLEY, ADAM (BSN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WHEATLEY
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 BRADY WAY
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3424
Mailing Address - Country:US
Mailing Address - Phone:435-553-1039
Mailing Address - Fax:
Practice Address - Street 1:3875 STADIUM WAY DEPT 3903
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-3903
Practice Address - Country:US
Practice Address - Phone:801-626-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program