Provider Demographics
NPI:1811974405
Name:WHEELER, GWENDOLYN E (FNP-BC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:E
Last Name:WHEELER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438
Mailing Address - Country:US
Mailing Address - Phone:985-839-4431
Mailing Address - Fax:985-795-0876
Practice Address - Street 1:2004 J MARVIN MAGEE DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438
Practice Address - Country:US
Practice Address - Phone:985-839-3555
Practice Address - Fax:985-839-6320
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN056993163W00000X
LAAP03660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1103489Medicaid
LAP38955Medicare UPIN
4B892Medicare ID - Type Unspecified
LA1103489Medicaid