Healthcare Provider Details

I. General information

NPI: 1578563219
Provider Name (Legal Business Name): ELIZABETH ANN WHEELER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BAY ST
STATEN ISLAND NY
10301-2563
US

IV. Provider business mailing address

840 TYSENS LN
STATEN ISLAND NY
10306-5662
US

V. Phone/Fax

Practice location:
  • Phone: 718-981-3366
  • Fax:
Mailing address:
  • Phone: 718-667-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420246-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: