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General NPI Number Information
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NPI Number | 1922232131
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Entity Type | Individual
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Provider Name | LISA A WHEELER PNP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 315 N WASHINGTON AVE STE 190
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City | COOKEVILLE
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State | TN
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Zip | 38501-5984
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Country | US
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Telephone | 931-528-3300
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Fax | 313-722-1029
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Provider Business Mailing Address
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Address Line | 315 N WASHINGTON AVE STE 190
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City | COOKEVILLE
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State | TN
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Zip | 38501-5984
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Country | US
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Telephone | 931-528-3300
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Fax | 313-722-1029
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN79264
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License Number State | TN
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