Healthcare Provider Details

I. General information

NPI: 1689500696
Provider Name (Legal Business Name): BRYAN ALEXANDER WHEELER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 S OREGON ST
YREKA CA
96097-3425
US

IV. Provider business mailing address

1517 S OREGON ST
YREKA CA
96097-3425
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-9200
  • Fax: 530-572-4661
Mailing address:
  • Phone: 530-842-9200
  • Fax: 530-572-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number825278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: