MEDICARE: MR. BLAKE ALAN WHEELER TELEMETRY TECH., CNA

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	374700000X	Technician		NV
2	376K00000X	Nurse's Aide	CNA027667	NV

General Provider Information

NPI Number	:	1730519729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAKE ALAN WHEELER TELEMETRY TECH., CNA

Provider Business Mailing Address
First Line	:	7701 FLOURISH SPRINGS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8212
Country	:	US
Telephone Number	:	702-372-8963
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 FLOURISH SPRINGS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8212
Country	:	US
Telephone Number	:	702-372-8963
Fax Number	:

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

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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