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NPI Code Detail

MEDICARE: TAMARA WHEELER

MEDICARE: TAMARA WHEELER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN088643-MEDSOH

General Provider Information

NPI Number : 1306372974
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA WHEELER
Provider Business Mailing Address
First Line : 1033 LARCHWOOD RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-2424
Country : US
Telephone Number : 419-747-4122
Fax Number :
Provider Business Practice Location Address
First Line : 1033 LARCHWOOD RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-2424
Country : US
Telephone Number : 419-747-4122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2017
Last Update Date : 05/02/2017

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Directions to “ TAMARA WHEELER ” Practice Location

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