Healthcare Provider Details

I. General information

NPI: 1124648365
Provider Name (Legal Business Name): ERIN MELISSA WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MELISSA HINCKLEY

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

IV. Provider business mailing address

777 CLINTON AVE S
ROCHESTER NY
14620-1448
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-6112
  • Fax: 217-324-5959
Mailing address:
  • Phone: 585-279-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number322013
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.162232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: