Healthcare Provider Details

I. General information

NPI: 1275660466
Provider Name (Legal Business Name): MARY ELIZABETH GERALDINE WHEELDON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEG WHEELDON NP-C

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 N CAMPUS RIDGE DR STE 2450
MIDLAND MI
48640-6112
US

IV. Provider business mailing address

4401 N CAMPUS RIDGE DR STE 2450
MIDLAND MI
48640-6112
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-1386
  • Fax: 989-839-3324
Mailing address:
  • Phone: 989-839-1386
  • Fax: 989-839-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number47024261842
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number69352
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704261842
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: