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NPI Code Detail

MEDICARE: CONNOR WAKEFIELD

MEDICARE: CONNOR WAKEFIELD
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
1207R00000XInternal Medicine Physician0101276689VA
2208D00000XGeneral Practice Physician0101276689VA
3390200000XStudent in an Organized Health Care Education/Training Program0101276689VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447814850
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR WAKEFIELD
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2019
Last Update Date : 03/16/2026

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Directions to “ CONNOR WAKEFIELD ” Practice Location

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