Provider Demographics
NPI:1780471698
Name:WHEATLEY, NICOLE J (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:WHEATLEY
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 E ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-7789
Mailing Address - Country:US
Mailing Address - Phone:217-552-0674
Mailing Address - Fax:
Practice Address - Street 1:3005 E ANTHONY DR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-7789
Practice Address - Country:US
Practice Address - Phone:217-552-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN