Healthcare Provider Details

I. General information

NPI: 1093818684
Provider Name (Legal Business Name): GAEL ANNE WHEELER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 NW 9TH ST
CORVALLIS OR
97330-3857
US

IV. Provider business mailing address

PO BOX 547
CORVALLIS OR
97339-0547
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-5047
  • Fax: 541-758-3713
Mailing address:
  • Phone: 541-758-5047
  • Fax: 541-758-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80409
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: