Provider Demographics
NPI:1700063906
Name:WHEATLEY, LIANA ELIZABETH (RN,OCN,CDT)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:ELIZABETH
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:RN,OCN,CDT
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:ELIZABETH
Other - Last Name:WELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 S DOWLEN RD # 43
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-1755
Mailing Address - Country:US
Mailing Address - Phone:409-201-4907
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE ST STE 104
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3059
Practice Address - Country:US
Practice Address - Phone:409-899-2860
Practice Address - Fax:409-899-4235
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse