MEDICARE: LISA M WHEELER NP

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	363LA2200X	Adult Health Nurse Practitioner	F304201	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000560977002	OTHER	NY	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134305378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M WHEELER NP

Provider Business Mailing Address
First Line	:	3024 NIAGARA FALLS BLVD STE 116
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1116
Country	:	US
Telephone Number	:	716-217-4321
Fax Number	:	716-219-2469

Provider Business Practice Location Address
First Line	:	3024 NIAGARA FALLS BLVD STE 116
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1116
Country	:	US
Telephone Number	:	716-217-4321
Fax Number	:	716-219-2469

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	03/07/2023

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Directions to “ LISA M WHEELER NP” Practice Location

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