Healthcare Provider Details

I. General information

NPI: 1093158412
Provider Name (Legal Business Name): JACYNDA LOUISE WHEELER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JACYNDA WNEK

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 M AVE STE G
ANACORTES WA
98221-3897
US

IV. Provider business mailing address

1211 24TH ST
ANACORTES WA
98221-2562
US

V. Phone/Fax

Practice location:
  • Phone: 360-299-4297
  • Fax: 360-299-4294
Mailing address:
  • Phone: 360-299-4297
  • Fax: 360-299-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR04-2013
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOP60585623
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: