MEDICARE: LYNDA R WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	522742	TX

General Provider Information

NPI Number	:	1134293707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA R WHEELER

Provider Business Mailing Address
First Line	:	1410 S GOLIAD ST APT 601
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75087-4636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 W MAGNOLIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4435
Country	:	US
Telephone Number	:	817-453-1844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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Directions to “ LYNDA R WHEELER ” Practice Location

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