MEDICARE: ANGELA 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
1	163W00000X	Registered Nurse	4704288361	MI

General Provider Information

NPI Number	:	1518332154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WHEELER

Provider Business Mailing Address
First Line	:	537 VAN ALLEN ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49548-1229
Country	:	US
Telephone Number	:	616-304-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	537 VAN ALLEN ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49548-1229
Country	:	US
Telephone Number	:	616-304-2036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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