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General NPI Number Information
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NPI Number | 1669778528
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Entity Type | Individual
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Provider Name | ETHYLN JOYCE WHEELER NP
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Gender | Female
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 569 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3260
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Country | US
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Telephone | 559-781-9301
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Fax | 559-782-7639
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Provider Business Mailing Address
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Address Line | 569 W. PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257
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Country | US
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Telephone | 559-781-9301
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Fax | 559-782-7639
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 7948
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License Number State | CA
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