Healthcare Provider Details

I. General information

NPI: 1811974405
Provider Name (Legal Business Name): GWENDOLYN E WHEELER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 J MARVIN MAGEE DR
FRANKLINTON LA
70438
US

IV. Provider business mailing address

1900 MAIN STREET
FRANKLINTON LA
70438
US

V. Phone/Fax

Practice location:
  • Phone: 985-839-3555
  • Fax: 985-839-6320
Mailing address:
  • Phone: 985-839-4431
  • Fax: 985-795-0876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP03660
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN056993
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: