Provider Demographics
NPI:1780180851
Name:WHEELER, SOFIA CATHERINE (PMHNP-BC, CRNP-PMH)
Entity type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:CATHERINE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PMHNP-BC, CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E STATE ST STE 209
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1572
Mailing Address - Country:US
Mailing Address - Phone:815-988-8500
Mailing Address - Fax:815-977-5956
Practice Address - Street 1:2222 E STATE ST STE 209
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:815-988-8500
Practice Address - Fax:815-977-5956
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health