Healthcare Provider Details

I. General information

NPI: 1013176916
Provider Name (Legal Business Name): DANIEL WARREN WHEELOCK M.ED. BA/FLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 BELL CORD AVE
N LAS VEGAS NV
89031-3714
US

IV. Provider business mailing address

4513 BELL CORD AVE
N LAS VEGAS NV
89031-3714
US

V. Phone/Fax

Practice location:
  • Phone: 702-736-8100
  • Fax:
Mailing address:
  • Phone: 702-736-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: