Healthcare Provider Details

I. General information

NPI: 1588133003
Provider Name (Legal Business Name): CHRISTEL GAYLE WHEELER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MCKINLEY AVE STE 1
DECATUR IL
62526-5858
US

IV. Provider business mailing address

210 W MCKINLEY AVE STE 1
DECATUR IL
62526-5858
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-6600
  • Fax:
Mailing address:
  • Phone: 217-876-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041375701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: