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General NPI Number Information
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NPI Number | 1306382726
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Entity Type | Individual
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Provider Name | MARYKATHRINE WHEATLEY NP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 5 MEDICAL PLAZA DR STE 190
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City | ROSEVILLE
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State | CA
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Zip | 95661-2867
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Country | US
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Telephone | 916-679-3590
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Fax | 916-482-3647
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Provider Business Mailing Address
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Address Line | 1300 ETHAN WAY STE 600
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City | SACRAMENTO
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State | CA
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Zip | 95825-2296
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 811923
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95006393
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95006393
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License Number State | CA
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