Healthcare Provider Details

I. General information

NPI: 1093662553
Provider Name (Legal Business Name): JENNIFER MARIE WHEELHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEN WHEELHOUSE

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31625 US-101
SOLEDAD CA
93960
US

IV. Provider business mailing address

PO BOX 546
HOLLISTER CA
95024-0546
US

V. Phone/Fax

Practice location:
  • Phone: 831-537-7124
  • Fax:
Mailing address:
  • Phone: 831-537-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAPCC21420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: