Provider Demographics
NPI:1740466887
Name:WHEELER, KATHLEEN SUE (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUE
Last Name:WHEELER
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG B 203
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3847
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE B3
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-674-3847
Practice Address - Fax:760-674-3845
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2016-03-01
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Provider Licenses
StateLicense IDTaxonomies
CA342965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ21076Medicare UPIN