Healthcare Provider Details

I. General information

NPI: 1558347773
Provider Name (Legal Business Name): ERIN L WHEELER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN L MALLON RNCFNP

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 17TH ST
KEOKUK IA
52632-3452
US

IV. Provider business mailing address

1706 W AGENCY RD
WEST BURLINGTON IA
52655-1667
US

V. Phone/Fax

Practice location:
  • Phone: 319-524-5734
  • Fax: 319-524-5758
Mailing address:
  • Phone: 319-768-5858
  • Fax: 319-752-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2000164074
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA1300376
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: