Healthcare Provider Details

I. General information

NPI: 1922075894
Provider Name (Legal Business Name): CARRIE LOUISE WHEELER GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD SUITE 502
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD SUITE 502
BALTIMORE MD
21239-2945
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-4720
  • Fax: 443-444-2110
Mailing address:
  • Phone: 443-444-4720
  • Fax: 443-444-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR194787
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: