Provider Demographics
NPI:1831823806
Name:WHEELER, NANCY E (CRNA, MS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:WHEELER
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 SANDCASTLE DR UNIT F
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8602
Mailing Address - Country:US
Mailing Address - Phone:802-478-4944
Mailing Address - Fax:
Practice Address - Street 1:1615 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3689
Practice Address - Country:US
Practice Address - Phone:715-685-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2212100163WC0200X
WI13226-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine