Healthcare Provider Details

I. General information

NPI: 1376335018
Provider Name (Legal Business Name): MADELINE WHEELER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3380
US

IV. Provider business mailing address

1034 N 500 W
PROVO UT
84604-3380
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-2137
  • Fax:
Mailing address:
  • Phone: 801-357-2137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14293220-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: