Provider Demographics
NPI:1841996139
Name:WHEAT, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WHEAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SATORI PKWY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6406
Mailing Address - Country:US
Mailing Address - Phone:317-266-9622
Mailing Address - Fax:
Practice Address - Street 1:301 SATORI PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6406
Practice Address - Country:US
Practice Address - Phone:317-266-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator