Provider Demographics
NPI:1982176780
Name:WHEELER, LAURA NICHOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICHOLE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3610
Mailing Address - Country:US
Mailing Address - Phone:573-569-2025
Mailing Address - Fax:
Practice Address - Street 1:489 LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3610
Practice Address - Country:US
Practice Address - Phone:573-569-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner