Healthcare Provider Details

I. General information

NPI: 1679151161
Provider Name (Legal Business Name): LAURA NIKELLE WHEELING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST BLDG 116
BOISE ID
83702-4599
US

IV. Provider business mailing address

500 W FORT ST BLDG 116
BOISE ID
83702-4599
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1165
  • Fax:
Mailing address:
  • Phone: 208-422-1165
  • Fax: 208-422-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1571460
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: