Healthcare Provider Details

I. General information

NPI: 1619922002
Provider Name (Legal Business Name): SARAH ANN WHEELIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 RICHARDS DR
DELAWARE OH
43015
US

IV. Provider business mailing address

407 COSHOCTON AVENUE
MOUNT VERNON OH
43050
US

V. Phone/Fax

Practice location:
  • Phone: 740-504-2764
  • Fax:
Mailing address:
  • Phone: 740-392-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberPN112179
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberLPN7887
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: