MEDICARE: JENNIFER WHEELER NNP-BC

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	363LN0000X	Neonatal Nurse Practitioner	RN277110	GA

General Provider Information

NPI Number	:	1710211123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WHEELER NNP-BC

Provider Business Mailing Address
First Line	:	3100 RIVER EXCHANGE DR APT 635
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-4231
Country	:	US
Telephone Number	:	417-827-0950
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 JOHNSON FY RD NE STE 680
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1608
Country	:	US
Telephone Number	:	678-990-5824
Fax Number	:

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

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	06/22/2024

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