MEDICARE: DR. ELIZABETH ANN 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	363LW0102X	Women's Health Nurse Practitioner	F420246-1	NY

General Provider Information

NPI Number	:	1578563219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN WHEELER NP

Provider Business Mailing Address
First Line	:	840 TYSENS LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5662
Country	:	US
Telephone Number	:	718-667-6712
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 BAY ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2563
Country	:	US
Telephone Number	:	718-981-3366
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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