Healthcare Provider Details

I. General information

NPI: 1285931279
Provider Name (Legal Business Name): JULIE ANN WHEELER IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22190 AVENUE E 1ST MEDICAL BATTALION, CLR-15, 1ST MLG, MARFORPAC
CAMP PENDLETON CA
92055-5657
US

IV. Provider business mailing address

PO BOX 555657 1ST MEDICAL BATTALION, CLR-15, 1ST MLG, MARFORPAC
CAMP PENDLETON CA
92055-5657
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-4912
  • Fax:
Mailing address:
  • Phone: 760-725-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: