MEDICARE: KAITLYN K WHEELAN

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	363L00000X	Nurse Practitioner	H165786	IA

General Provider Information

NPI Number	:	1720759400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN K WHEELAN

Provider Business Mailing Address
First Line	:	1100 5TH ST STE 210
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2934
Country	:	US
Telephone Number	:	319-594-5953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 5TH ST STE 210
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2934
Country	:	US
Telephone Number	:	319-594-5953
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	10/08/2021

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Directions to “ KAITLYN K WHEELAN ” Practice Location

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